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Abstract：
BACKGROUND: The heparin sensitivity index (HSI) is closely associated with perioperative ischemic events and increased blood loss in cardiac surgery. Previous studies have produced conflicting results. Therefore, this study aimed to investigate the relationship between HSI and postoperative blood loss specifically in Chinese patients undergoing elective off-pump coronary artery bypass grafting (OPCAB).
METHODS: Patients underwent OPCAB between March 2021 and July 2022 were retrospectively included. Enrolled patients were classified into Low-HSI (HSILOW; HSI < 1.3) and Normal-HSI (HSINORM; HSI ≥ 1.3) groups. HSI = [(activated clotting time (ACT) after heparin) - (baseline ACT)] / [loading dose of heparin (IU/kg)]. Primary outcome included postoperative blood loss at 24 h. Secondary outcomes were total postoperative blood loss, transfusion requirement of red blood cell (RBC), fresh frozen plasma (FFP), platelet concentrates (PC), and other complications.
RESULTS: We retrospectively analyzed 303 Chinese OPCAB patients. HSILOW group had higher preoperative platelet (PLT) count (221 × 109/L vs. 202 × 109/L; P = 0.041) and platelet crit (PCT) value (0.23% vs. 0.22%; P = 0.040) compared to HSINORM group. Two groups showed no significant differences in postoperative blood loss at 24 h (460 mL vs. 470 mL; P = 0.252), total blood loss (920 mL vs. 980 mL; P = 0.063), RBC transfusion requirement (3.4% vs. 3.1%; P = 1.000), FFP transfusion requirement (3.4% vs. 6.2%; P = 0.380), and other complications. Preoperative high PLT count was associated with low intraoperative HSI value (odds ratio: 1.006; 95% confidence interval: 1.002, 1.011; P = 0.008).
CONCLUSIONS: Intraoperative HSI value was not associated with postoperative blood loss in Chinese patients undergoing OPCAB. Preoperative high PLT count was an independent predictor of low intraoperative HSI value.
METHODS: Patients underwent OPCAB between March 2021 and July 2022 were retrospectively included. Enrolled patients were classified into Low-HSI (HSILOW; HSI < 1.3) and Normal-HSI (HSINORM; HSI ≥ 1.3) groups. HSI = [(activated clotting time (ACT) after heparin) - (baseline ACT)] / [loading dose of heparin (IU/kg)]. Primary outcome included postoperative blood loss at 24 h. Secondary outcomes were total postoperative blood loss, transfusion requirement of red blood cell (RBC), fresh frozen plasma (FFP), platelet concentrates (PC), and other complications.
RESULTS: We retrospectively analyzed 303 Chinese OPCAB patients. HSILOW group had higher preoperative platelet (PLT) count (221 × 109/L vs. 202 × 109/L; P = 0.041) and platelet crit (PCT) value (0.23% vs. 0.22%; P = 0.040) compared to HSINORM group. Two groups showed no significant differences in postoperative blood loss at 24 h (460 mL vs. 470 mL; P = 0.252), total blood loss (920 mL vs. 980 mL; P = 0.063), RBC transfusion requirement (3.4% vs. 3.1%; P = 1.000), FFP transfusion requirement (3.4% vs. 6.2%; P = 0.380), and other complications. Preoperative high PLT count was associated with low intraoperative HSI value (odds ratio: 1.006; 95% confidence interval: 1.002, 1.011; P = 0.008).
CONCLUSIONS: Intraoperative HSI value was not associated with postoperative blood loss in Chinese patients undergoing OPCAB. Preoperative high PLT count was an independent predictor of low intraoperative HSI value.
摘要：
背景：肝素敏感性指数（HSI）与心脏手术围手术期缺血事件和失血量增加密切相关。先前的研究产生了相互矛盾的结果。因此,本研究旨在探讨中国择期非体外循环冠状动脉旁路移植术(OPCAB)患者HSI与术后失血的关系.
方法：回顾性纳入2021年3月至2022年7月接受OPCAB的患者。纳入患者分为低HSI组（HSILOW;HSI<1.3）和正常HSI组（HSINORM;HSI≥1.3）。HSI=[(肝素后活化凝血时间(ACT))-(基线ACT)]/[肝素负荷剂量(IU/kg)]。主要结果包括术后24h失血。次要结果是术后总失血，红细胞（RBC）的输血需求，新鲜冷冻血浆（FFP），血小板浓缩物（PC），和其他并发症。
结果：我们回顾性分析了303例中国OPCAB患者。HSILOW组术前血小板（PLT）计数较高（221×109/Lvs.202×109/L；P=0.041）和血小板凝固（PCT）值（0.23％vs.0.22%；P=0.040）与HSINORM组比拟。两组术后24h失血量无显著差异（460mL与470mL；P=0.252），总失血量（920毫升vs.980mL;P=0.063),红细胞输血需求（3.4%vs.3.1%；P=1.000），FFP输血需求（3.4%vs.6.2%；P=0.380），和其他并发症。术前高PLT计数与术中低HSI值相关(比值比:1.006;95%置信区间:1.002,1.011;P=0.008)。
结论：中国OPCAB患者术中HSI值与术后失血无关。术前高PLT计数是术中低HSI值的独立预测因子。
方法：回顾性纳入2021年3月至2022年7月接受OPCAB的患者。纳入患者分为低HSI组（HSILOW;HSI<1.3）和正常HSI组（HSINORM;HSI≥1.3）。HSI=[(肝素后活化凝血时间(ACT))-(基线ACT)]/[肝素负荷剂量(IU/kg)]。主要结果包括术后24h失血。次要结果是术后总失血，红细胞（RBC）的输血需求，新鲜冷冻血浆（FFP），血小板浓缩物（PC），和其他并发症。
结果：我们回顾性分析了303例中国OPCAB患者。HSILOW组术前血小板（PLT）计数较高（221×109/Lvs.202×109/L；P=0.041）和血小板凝固（PCT）值（0.23％vs.0.22%；P=0.040）与HSINORM组比拟。两组术后24h失血量无显著差异（460mL与470mL；P=0.252），总失血量（920毫升vs.980mL;P=0.063),红细胞输血需求（3.4%vs.3.1%；P=1.000），FFP输血需求（3.4%vs.6.2%；P=0.380），和其他并发症。术前高PLT计数与术中低HSI值相关(比值比:1.006;95%置信区间:1.002,1.011;P=0.008)。
结论：中国OPCAB患者术中HSI值与术后失血无关。术前高PLT计数是术中低HSI值的独立预测因子。
