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The authors are now engaged in a chronic experiment of left heart bypass on calves weighting 80-100kg. In the conduct of such a mechanical assistance procedure it is important that post-operative thrombogenesis should be prevented and therefore an appropriate anti-thrombogenic therapy should be administered by the use of some method. The authors first attempted general heparinization by one-shot intravenous injection of heparin, but in this method it was difficult to maintain a constant heparin level and thus extensive bleeding tendency was frequency observed. In order to prevent the risk of bleeding due to general heparinization and to remove the possibility of thrombosis within the bypass circuit it would be an ideal method to maintain a non-clottable condition only within the bypass circuit. To satisfy this purpose it was considered that local heparinization by which heparinization would be confined as much as possible to the bypass circuit and blood neutralized by protamine would be circulated throughout the body would be effective. The authors therefore attempted a method in which heparin was continuously injected into the inlet side of the bypass circuit and protamine was continuously injected into the outlet side of the circuit so that heparinized blood would be neutralized. At present, as postoperative anti-thrombogenic therapy this local heparinization method is employed during the first post-operative week. Heparin at a dose of 25U/kg/h and protamine at a dose of 10-25U/kg/h are continuously injected and the prothrombin time is controlled at a level 1.5-2.0 times that of normal value, providing comparatively satisfactory anti-thrombogenic effects. However, this method is somewhat complicated and there is a danger that accident might develop through mixture of air. Therefore, as a safer and simpler method the authors have attempted an anti-coagulation procedure of orally administered Warfarin from the first post-operative week.This method has been conducted on 7 cases. As it was somewhat difficult to control the prothrombin time within the desired range by Warfarin, the prothrombin time was slightly extended beyond that observed during local heparinization, but bleeding tendency was not observed in the animal. Adequate and safe anti-thrombogenic effect was obtained without any special side effect due to Warfarin.

A study on local heparinization and blood coagulation in left heart bypass