Kogan Alexander, Preisman Sergey, Sternik Leonid, Orlov Boris, Spiegelstein Dan, Hod Hanoch, Malachy Ateret, Levin Shany, Raanani Ehud
Department of Cardiothoracic Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Card Surg. 2012 Jul;27(4):434-7. doi: 10.1111/j.1540-8191.2012.01484.x.
Anticoagulation with heparin is recommended in patients with an intra-aortic balloon pump (IABP) to prevent thrombosis and embolization. However, anticoagulation increases the risk of bleeding, particularly in the early postoperative period after cardiac surgery. We investigated the safety of heparin-free management after IABP insertion in patients who underwent cardiac surgery.
We studied 203 consecutive patients who received perioperative IABP support between August 2004 and December 2011. All patients were managed without heparin and were followed for thrombotic and/or hemorrhagic complications.
Patients were divided into two groups, according to time of IABP treatment following surgery. Group I, 81 patients (39.9%) were treated less than 24 hours following surgery and Group II, 122 patients (60.1%) were treated more than 24 hours following surgery. Vascular complications developed in seven patients (3.4%), two in Group I and five in Group II. Three patients had major and four had minor limb ischemia. There were no major bleeding complications, but minor bleeding complications were observed in eight patients (4.2%).
In patients undergoing cardiac surgery with IABP support, the rate of thromboembolic complications was relatively low compared to historical controls. Heparin-free management may reduce the risk of hemorrhagic complications, with a low risk of thrombotic complications. Heparin should not be routinely used in patients requiring IABP after cardiac surgery.
对于使用主动脉内球囊反搏（IABP）的患者，推荐使用肝素进行抗凝以预防血栓形成和栓塞。然而，抗凝会增加出血风险，尤其是在心脏手术后的早期。我们研究了心脏手术后插入IABP的患者采用无肝素管理的安全性。
我们研究了2004年8月至2011年12月期间连续接受围手术期IABP支持的203例患者。所有患者均未使用肝素进行管理，并对血栓形成和/或出血并发症进行随访。
根据手术后IABP治疗时间，患者分为两组。第一组，81例患者（39.9%）在手术后24小时内接受治疗，第二组，122例患者（60.1%）在手术后24小时后接受治疗。7例患者（3.4%）出现血管并发症，第一组2例，第二组5例。3例患者出现严重肢体缺血，4例患者出现轻度肢体缺血。未发生严重出血并发症，但8例患者（4.2%）出现轻度出血并发症。
在接受IABP支持的心脏手术患者中，与历史对照相比，血栓栓塞并发症的发生率相对较低。无肝素管理可能会降低出血并发症的风险，血栓形成并发症的风险也较低。心脏手术后需要IABP的患者不应常规使用肝素。
