IJCS | Volume 33, Nº3, May / June 2020

DOI: https://doi.org/10.36660/ijcs.20200077 Antithrombotic agents include anticoagulants, antiplatelet and fibrinolytic drugs. They are prescribed in several situations related to hemostasis disturbances that favor thrombi formation. Since bleeding is a common adverse effect of these drugs, a cost-benefit analysis of antithrombotic therapy prior to surgery should be performed. 1 In order to consider the preoperative therapy for patients undergoing cardiac surgery, the risk of thrombosis must outweigh the risk of bleeding. Nonetheless, the literature has reported the use of anticoagulant therapy with unfractionated heparin (UFH) during extracorporeal circulation (ECC) inside and outside the cardiac operating room. 1-4 The development of the heart-lung machine made ECC possible. Therefore, heart surgery became a routine practice. The literature describes that complications related to ECC have diminished due to modern monitoring, highly trained staff, special cannulation methods, as well as the latest advances in techniques. 2 However, some authors suggest that guidelines based on more researches would improve the safety of this procedure. 3 During cardiac surgery, ECC preserves the functional characteristics of the heart, provides a clean surgical environment and offers safety to the team. 4 Heparin is a sulfated polysaccharide. It was the first anticoagulant drug approved and is one of the oldest in clinical use, being the second most widely used pharmaceutical drug by mass. Glycosaminoglycan heparin is a natural compound processed to pharmaceutical grade heparin, which can undergo controlled depolymerization to produce low-molecular-weight heparins (LMWHs), whose molecular weights are approximately one-third that of the parent heparin. UFH binds with high affinity to antithrombin, increasing its ability to inhibit both factor Xa and thrombin in the coagulation cascade, whilst LMWHs primarily inhibit factor Xa, and are used therapeutically because of their improved pharmacokinetics and reduced side e ects over UFH. 5,6 UFH has also been manufactured from different mammalian sources, such as porcine (pig), bovine (cow) and ovine (sheep) tissues. Nowadays, there are some concerns about a shortage of porcine heparin. Thus, regulatory agencies are currently considering the introduction of bovine UFH for parenteral indications, and ovine heparin is being developed in non-US markets. 6 For this reason, recent studies have discussed the use of bovine UFH in cardiac surgery. 7,8 The paper published by Torres et al., 7 in the International Journal of Cardiovascular Sciences, reports the safety of bovine UFH evaluated during cardiac pump surgery. The study included a retrospective and descriptive analysis. The authors analyzed the medical records of all patients undergoing cardiac surgery with ECC using bovine UFH (supplied by Eurofarma Laboratories S.A.), between October 2008 and November 2012, and porcine UFH (supplied by Cristália and Blausiegel Laboratories), between June 2013 and December 2014, at the Heart Surgery Institute of Hospital Bom Jesus in Ponta Grossa (Paraná, Brazil). Patients were excluded from the study if they had received UFH, LMWH, oral anticoagulants and/or fibrinolytics before the procedure. They were also excluded in case of absence of preoperative platelet count and/or cardiac surgery performed in the presence of severe sepsis, with high risk of widespread intravascular coagulation. Pre- and postoperative 243 EDITORIAL International Journal of Cardiovascular Sciences. 2020; 33(3):243-244 Mailing Address: Christianne Bretas Vieira Scaramello Rua Prof. Hernani Mello, 101. Postal Code: 24210-130, Niterói, RJ – Brazil. E-mail: chrisbretas@gmail.com Is Bovine Heparin, an Old Fellow, a Safe Anticoagulation Approach during Extracorporeal Circulation Inside the Cardiac Operating Room? Ivis Levy Fernandes Martin s a nd Christianne Bretas Vieira Scaramell o Universidade Federal Fluminense, Niterói, RJ – Brazil Heparin; Blood Coagulation; Extracorporeal Circulation; Cardiac Surgical Prcedures; Patient Safety. Keywords