Abstract 1798: Influence of Heparin Brand on Immediate Post-Operative Outcomes in Children Undergoing Cardiac Surgery
Adult studies have shown that specific brands of unfractionated heparin are associated with differences in early post-operative outcomes, for surgeries using cardiopulmonary bypass. We sought to determine if the use of specific unfractionated heparin brands was associated with differences in post-operative outcomes of pediatric cardiac surgery. We compared postoperative outcomes from September 2004-June 2005 when Hepalean® (Organon Teknika) heparin was used to outcomes of surgeries performed between June 2006-December 2007 when generic PPC (Pharmaceutical Partners of Canada, Inc.) heparin was used. Surgeries performed in between these dates were excluded as both brands were used simultaneously. Differences in outcomes were estimated in multivariable logistic and linear regression models adjusted for era, previous surgeries, age at operation, Aristotle score, bypass time, cross-clamp time, deep hypothermic circulatory arrest, surgeon, O2 saturation prior to operation, total heparin dose and use of antifibrinolytic agents. A total of 903 surgeries were reviewed, 289 (32%) associated with use of Hepalean® and 614 (68%) with generic PPC heparin. Patients demographics and surgical variables were balanced between groups with the exception of marginally longer cardiopulmonary bypass time in the Hepalean® group (113±61 mins vs. 100±52 mins, p=0.002) and preferential use of tranexamic acid vs. aprotinin in the PPC heparin group (69% vs. 50%, p<0.001). In multivariable regression, the use of PPC heparin was associated with greater red blood cell transfusions in the first 24 hours after surgery (PE: 0.138 (0.040) log ml/kg, p=0.001), longer ICU stay (PE: 0.684 (0.057) log days, p<0.001), longer hospital stay (PE: 0.331 (0.039) log days, p<0.001), greater odds of hemorrhagic complications (OR: 7.0, 95%CI (2.0 –24.2), p=0.003) and early reoperation (OR: 5.3, 95%CI (1.0 –28.0), p=0.05). T requirements and surgical outcomes were found to be associated with the specific brand of unfractionated heparin used with pediatric cardiac surgery. Randomized controlled trials are needed to confirm this observation, but the unfractionated heparin brand should be included as a potential confounder in future pediatric surgical studies.