Imran Khan, Irfan Azmatullah Khwaja, Ajwad Farogh, Hadia Mannan Mian, Madiha Iqbal, Zia-ur Rehman.
Heparin; Does Heparin Resistance Lead To Poor Early Outcome in patients Undergoing on Pump Coronary Artery Bypass Grafting?.
Professional Med J Jan ;25(3):340-4.

Background: Heparin resistance (HR) is a well-known phenomenon in patients undergoing cardiac surgery. Its effect on outcome has not been studied well. Study Design: Prospective observational study. Setting: Department of Cardiac Surgery, Punjab Institute of Cardiology Lahore. Period: April 2013 to March 2015. Materials and Methods: The study included 300 consecutive patients undergoing on pump coronary artery bypass grafting (CABG). Those with severe left ventricular dysfunction, multiple cardiac procedures and emergency CABG were excluded from the study. Data was collected on proformas with perioperative variables. The data was analyzed using Statistical Package for Social Sciences version 10. Results: A total of 300 patients were included in the study. This included 60(20%) female patients. The mean age of the patients was 50.76 ±4.67 years. Out of the studied cohort, 30(10%) patients showed heparin resistance. Clinical characteristics i.e. hypertension, diabetes mellitus, smoking, hyperlipidaemias and obesity did not show any significance when patients with and without heparin resistance were compared. Total drain was significantly more in group 1 (700±150.13 ml) compared to group 2 (500±120.33 ml) with p=0.023. Similarly, renal failure in group 1 vs group 2 (30.0% vs 15.4%. p=.017), use of blood products more than two units in group 1 vs group 2 (83.30% vs 10.7%, p= .003), re-exploration for bleeding in group 1 vs group 2 (30.0% vs 5.5%, p=.003) was significantly more in group 1 vs group 2 respectively. Mortality was insignificant in both groups. Conclusion: Heparin resistance occurred in 10% of the patients. Patients with heparin resistance lead to poor postoperative outcomes like increased renal failure, bleeding, rate of re-exploration and increased use of blood products but does not lead to increased mortality in patient with comparatively lower risk profile.

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