Management of Heparin Infusion Before CABG Surgery

Rationale for Continuing Current Heparin Infusion

• For patients with an intra-aortic balloon pump (IABP) who are scheduled for CABG, the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines recommend continuing unfractionated heparin infusion until surgery, as it provides more stable anticoagulation levels compared to intermittent dosing 1, 2
• The ACC/AHA guidelines clearly state that for patients in whom CABG is selected as a management strategy, anticoagulant therapy should be managed by continuing UFH, which has a short half-life allowing for easier management during surgery 3, 1

Importance of Continuous Anticoagulation with IABP

• Patients with an IABP require continuous anticoagulation to prevent thrombus formation on the device surface, and the current continuous infusion regimen provides more predictable anticoagulation, which is critical for IABP management 2
• The current continuous infusion regimen provides more predictable anticoagulation, which is critical for IABP management, and is preferred over intermittent dosing 1, 4

Perioperative Anticoagulation Management

• UFH is the preferred anticoagulant for patients proceeding to CABG as it can be continued until the procedure, and the surgical team can simply stop the infusion when needed during the procedure, providing flexibility in timing 1, 5
• Unlike other anticoagulants, UFH infusion can be continued until the procedure, and the surgical team can simply stop the infusion when needed during the procedure, providing flexibility in timing 2, 6

Monitoring Recommendations

• Consider checking hemoglobin levels and monitoring for any signs of bleeding, as well as monitoring platelet counts regularly to detect potential heparin-induced thrombocytopenia 7

Common Pitfalls to Avoid

• Increasing the dose unnecessarily may increase bleeding risk during surgery, and discontinuing anticoagulation completely before surgery in a patient with an IABP could lead to device thrombosis 7, 4
• Discontinuing anticoagulation completely before surgery in a patient with an IABP could lead to device thrombosis, and the patient's current anticoagulation status should be communicated to the surgical team 2

Special Considerations

• The surgical team should be informed about the patient's current anticoagulation status to prepare accordingly for the procedure, and postoperatively, aspirin therapy should be initiated or continued for all CABG patients, ideally within 6 hours after surgery 5, 6, 7