scholarly journals More effective anticoagulation during non-cardiac arterial procedures using Activated Clotting Time guided heparin administration

2021 ◽  
Author(s):  
Orkun Doganer ◽  
Arno M. Wiersema ◽  
Maurice Pierie ◽  
Jan D. Blankensteijn ◽  
Kak Khee Yeung ◽  
...  
Keyword(s):  
Clotting Time ◽  
Activated Clotting Time ◽  
Heparin Administration

Heparin Administration And Precision Protamine Reversal In Coronary Bypass Surgery

1981 ◽  
Author(s):  
Charles Markham
Keyword(s):  
Blood Loss ◽  
Coronary Bypass ◽  
Testing Procedure ◽  
Published Data ◽  
Clotting Time ◽  
Test Protocol ◽  
Precise Control ◽  
Activated Clotting Time ◽  
Heparin Administration ◽  
Recalcification Time

A two-tiered testing procedure was developed which uses the activated clotting time (ACT) dose-response curve for the initialization and maintenance of heparinization while using the whole blood activated recalcification time (wBART) for a more precise control of protamine neutralization. The wBART, the most sensitive test for heparin induced hypocoagulability, parallels the ACT and is prolonged by protamine excess, allowing a rapid and accurate titration procedure. This twotiered test protocol results in decreased protamine usage and less blood loss compared to published data in a comparable patient population.The protocol was applied to a study with 55 by-pass patients to compare two commercial beef lung heparins with respect to anticoagulant effectiveness, intraoperative ACT levels, total heparin usage, post-operative blood loss and protamine requirements. Platelet counts were also monitored before and following surgery. No statistically significant differences were observed between the two heparin products in any of these parameters. Details of the two-tiered protocol and the beef lung heparin study will be presented.

Abstract 16805: Assessing Correlation and Agreement in Activated Clotting Time (ACT) Measurement Using Hemochron Signature Elite

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ankita Aggarwal ◽  
Anubhav Jain ◽  
Arjun Bhardwaj ◽  
Nishit Choksi
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
P Value ◽  
Clotting Time ◽  
Paired Samples ◽  
Activated Clotting Time ◽  
Cardiac Procedures ◽  
Heparin Administration ◽  
Device Reliability ◽  
Before And After

Introduction & Hypothesis: ACT is the preferred mode of assessing degree of anti-coagulation during cardiac catheterization. Studies have shown significant variability in ACT measurement with different company analysers. We aimed to assess correlation and agreement between two instruments of the same company, Hemochron Signature Elite. Method: Paired samples were collected before and after heparin administration for each patient. Each paired sample was collected and entered into the two instruments tagged A & B using the same syringe and at the same time. Results: A total of 46 samples were included in the study. There was a significant correlation between the two instruments (r= 0.92, p- value 0.02). However, the two devices had significant discordance with a mean bias of 11.1 , 95% CI 0.77 to 24.9 and limits of agreement -35.8 to 58.1. Mean ACT between the two devices was significantly different (231 vs 248, p-value 0.01). Inter-device reliability was 30%. There was a more than 10% difference in about 30% of the paired samples and more than 20% difference in 9% of the samples. Conclusion: Significant correlation but discordance exists in ACT measurement even between the same type of device. This may affect clinical decision making during cardiac procedures and need further investigation.

Conventional Weight-Based versus Low-Dose Regimen of Heparin Administration to Achieve Target Activated Clotting Time on Cardiopulmonary Bypass in Pakistani Population

2021 ◽  
Vol 17 (1) ◽  
pp. 34-39
Author(s):  
Musfireh Siddiqeh ◽  
Wajahat Javed Mirza ◽  
Javed Iqbal ◽  
Imran Khan ◽  
Ali R Mangi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Low Dose ◽  
Clotting Time ◽  
Heparin Dose ◽  
Pakistani Population ◽  
Activated Clotting Time ◽  
Heparin Administration ◽  
Group A ◽  
Group B ◽  
Additional Dosage

Objective: A weight-based dose of heparin is calculated to achieve target ACT (Activated clotting time) for establishing CPB (cardiopulmonary bypass). Whether a target ACT can be achieved with lower dose of heparin in Pakistani population was the aim of this study. Methodology: The cross-sectional comparative study was conducted at Rawalpindi Institute of Cardiology, Department of Cardiac Surgery from 1st January 2019 to 1st January 2020. Three hundred thirty-six (336) patients undergoing elective open-heart surgeries on CPB were included in this study. Patients receiving weight-based heparin dose were placed in Group-A, while those on low-dose heparin were placed in Group-B. ACT was considered to have reached the target value in range of 400-480 seconds, values between 481-1500 seconds were considered excessive, whereas ACT of >1500 was regarded as potentially high-risk for peri-operative bleeding . Results: 14.1% (n= 28) of Group-A patients achieved target ACT, whereas 58.3% (n=116) exceeded the target of 480. In 25.1% (n=50), ACT values were beyond the measuring capacity of the assay machine i.e. >1500. Only 2.5% (n=5) required additional dosage of heparin. Target ACT in Group B was achieved in 19.7% (n= 27), 55.5% (n=76) had excessive ACT values, whereas in 16.8% (n= 23), it was >1500. 9.5% (n=13) required an additional dosage of Heparin. Conclusion: In Pakistani population, a target ACT can be achieved with significantly lower dose than the conventional weight-based heparin dose. Larger studies, preferably randomized controlled trials are needed to determine the optimal heparin dose calculation for safe anti-coagulation during CPB.

scholarly journals Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron® Response and Hemochron® Signature Elite

Perfusion ◽  
2021 ◽  
pp. 026765912110493
Author(s):  
Roland F Hoffmann ◽  
Sandra Horsten ◽  
Massimo A Mariani ◽  
Adrianus J de Vries
Keyword(s):  
Measurement Errors ◽  
Artery Bypass ◽  
Repeated Measurements ◽  
Arterial Line ◽  
Positive Bias ◽  
Clotting Time ◽  
Activated Clotting Time ◽  
Heparin Administration ◽  
Response Versus ◽  
Protamine Administration

Introduction: The Activated Clotting Time (ACT) is commonly used to manage anticoagulation during cardiac surgery. The aim of this study was to compare the older manually operated Hemochron® Response and the automated Hemochron® Signature Elite. Methods: In this observational study the clinically relevant differences of both devices were investigated simultaneously, using duplicate measurements, in 29 patients who underwent a Coronary Artery Bypass Grafting (CABG) or Aortic Valve Replacement (AVR) in order to determine reliability, bias, and to detect which method has the lowest variation. Blood samples were obtained from the arterial line prior to surgery, after administration of 300 IU/kg heparin, 5 minutes after initiation of cardiopulmonary bypass and successively every 30 minutes, and after protamine administration. Results: A total of 202 measurements were performed. Of these 10 measurements were out of range in the Response and 9 in the Elite. About 27 single unstable magnet errors were seen in the Response versus no measurement errors in the Elite. No statistically significant differences between the Response (p = 0.22, Wilcoxon rank) and Elite (p = 0.064) duplicates were observed. The Response values were consistently higher during heparinization than the Elite measurements (p = 0.002, repeated measurements) with an average positive bias of around 56 seconds during heparinization (Bland-Altman). Overall, the coefficient of variation (CoV) increased during heparinization. Conclusion: The Elite was more reliable, but the variation was higher for the Elite than the Response. The observed positive bias in the Response compared to the Elite could affect heparin administration during surgery making the two systems not interchangeable.

scholarly journals Evaluation of a New Sonoclot Device for Heparin Management in Cardiac Surgery

2016 ◽  
Vol 23 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Omer Dzemali ◽  
Michael T. Ganter ◽  
Alicja Zientara ◽  
Kirk Graves ◽  
Renate Behr ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Glass Bead ◽  
Percentage Error ◽  
Altman Analysis ◽  
Clotting Time ◽  
Bland Altman Analysis ◽  
New Device ◽  
Activated Clotting Time ◽  
Heparin Administration ◽  
Target Values

Background: Sonoclot is used to measure kaolin-based activated clotting time (kACT) for heparin management. Apart from measuring kACT, the device assesses the patient’s coagulation status by glass bead–activated tests (gbACTs; measuring also clot rate [CR] and platelet function [PF]). Recently, a new version of the Sonoclot has been released, and the redesign may result in performance changes. The aim of this study was to evaluate and compare the performance of the new (S2) and the previous (S1) Sonoclot. Methods: The S1 was used in the routine management of 30 patients undergoing elective cardiac surgery. Blood samples were taken at baseline (T1), after heparin administration (200 U/kg, 100 U/kg; T2 and T3), during cardiopulmonary bypass (T4), after protamine infusion (T5), and before intensive care unit transfer (T6). Kaolin-based activated clotting time and gbACTs were measured in duplicate by both the old and the new device and performance compared by Bland-Altman analysis and percentage error calculation. Results: A total of 300 kACT and 180 gbACTs were available. Bland-Altman analysis for kACT revealed that S2 consistently reported results in shorter time compared to S1 (overall = −14.7%). Comparing S2 and S1, the glass bead–activated tests showed mean percentage differences of −18.9% (gbACTs), +37.4% (CR), and −3.7% (PF). Conclusion: Since clotting is faster in the new S2 compared to S1, shorter clotting times have to be considered in clinical practice. The use of S2 kACT in heparin management will result in higher heparin and protamine dosing unless heparin kACT target values are adjusted to correct for the differences in results between S1 and S2.

scholarly journals The role of the activated clotting time in heparin administration and neutralization for cardiopulmonary bypass

1983 ◽  
Vol 85 (2) ◽  
pp. 174-185 ◽  
Author(s):  
Rick A. Esposito ◽  
Alfred T. Culliford ◽  
Stephen B. Colvin ◽  
Stephen J. Thomas ◽  
Henriette Lackner ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Clotting Time ◽  
Activated Clotting Time ◽  
Heparin Administration

Factors influencing activated clotting time following heparin administration for the initiation of cardiopulmonary bypass

2020 ◽  
Vol 69 (1) ◽  
pp. 38-43
Author(s):  
Satoshi Matsushita ◽  
Akinori Kishida ◽  
Yoshihito Wakamatsu ◽  
Hiroshi Mukaida ◽  
Hirohide Yokokawa ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Clotting Time ◽  
Factors Influencing ◽  
Activated Clotting Time ◽  
Heparin Administration

scholarly journals Global cerebral infarction after aortic arch replacement surgery in a patient with postoperatively revealed factor XII deficiency: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Keisuke Yoshida ◽  
Shiori Tanaka ◽  
Yuki Sato ◽  
Kazuhiro Watanabe ◽  
Kenichi Muramatsu ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Infarction ◽  
Acute Type ◽  
Factor Xii ◽  
Clotting Time ◽  
Type A Aortic Dissection ◽  
Factor Xii Deficiency ◽  
Replacement Surgery ◽  
Activated Clotting Time ◽  
Heparin Administration

Abstract Background This case report presents a case of a patient with global cerebral infarction of uncertain etiology following an emergency surgery for acute type A aortic dissection. As a result, factor XII deficiency was revealed postoperatively. To date, there have been several reports of cardiovascular surgery in patients with factor XII deficiency. However, all previous reports were of patients whose factor XII deficiency had been detected preoperatively; therefore, before this, there had been no reports of complications associated with factor XII deficiency following cardiovascular surgery. Case presentation We report a case of emergency aortic arch replacement surgery for acute type A aortic dissection in a 57-year-old Japanese man. A blood test prior to the surgery showed coagulopathy, a platelet count of 117 × 109/L, a prothrombin time–international normalized ratio of 1.78, an activated partial thromboplastin time of 69.7 seconds, and fibrinogen < 50 mg/dl. A smaller-than-usual dose of heparin (8000 IU) was administered because the patient’s activated clotting time was extremely prolonged (> 999 seconds). After the heparin administration, the activated clotting time, measured every 30–60 minutes, remained unchanged (> 999 seconds); therefore, additional heparin was not administered during the surgery, and there was no clinical problem during cardiopulmonary bypass. However, a diagnosis of global cerebral infarction was made on the first postoperative day. An additional blood coagulation test performed on postoperative day 9 revealed factor XII deficiency (8.0%). Regarding the reason that global cerebral infarction occurred in the present case, two reasons were considered: One was factor XII deficiency itself, and the other was low-dose heparin administration during the cardiopulmonary bypass due to excessively prolonged activated clotting time caused by factor XII deficiency. Conclusions Factor XII deficiency should be considered in patients with prolonged activated clotting time and spontaneous thrombosis in vascular surgeries. Moreover, the present case emphasizes that management of heparin during cardiopulmonary bypass should not be performed on the basis of activated clotting time monitoring alone, especially in a case with prolonged activated clotting time.

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