Activation of the clotting system:: heparin-coated versus non coated systems for extracorporeal circulation

The purpose of this experimental study was to compare heparin-coated versus noncoated systems for extracorporeal membrane oxygenation (ECMO), to investigate the dynamic course of clotting activation in both groups. Methods. Eight pigs weighing 19.7 (+/- 1.3) kg, each underwent ECMO for 24 hours. Two groups were formed: in group 1, heparin-coated circuits were used with low dose heparinization (10 IU/kg/hr), whereas in group 2 non-coated circuits with high dose heparinization (60 IU/kg/hr) were used Coagulation was monitored by measuring prothrombin time, partial thromboplastin time, fibrinogen, antithrombin III (AT III) and specific markers of clotting activation (thrombin-antithrombin III complexes (TAT) and D-dimer). Furthermore, platelet count, hematocrit, activated clotting time (ACT), and plasma heparin concentration were determined regularly. Results. The dynamic course of the specific coagulation activation markers showed some differences: whereas TAT and D-dimer increased quickly in group 2, the increase in group 1 was delayed. Activation marker Values tended to be fewer in group I during the first six hours, alter which no more differences between the groups were seen. After 24 hours of ECMO, TAT and D-dimer had nearly returned to baseline values. Platelets showed a continuous decrease throughout the experiment, which was very similar in both groups. Conclusions. The heparin coated system showed a distinct delay in clotting activation during the first six hours of ECMO. After six hours there were no more differences between the groups.