Anticoagulation Monitoring Under ECMO Support: A Comparative Study Between the Activated Coagulation Time and the Anti-Xa Activity Assay

2018 ◽  
Vol 35 (7) ◽  
pp. 679-686 ◽  
Author(s):  
Clément Delmas ◽  
Aemilia Jacquemin ◽  
Fanny Vardon-Bounes ◽  
Bernard Georges ◽  
Felipe Guerrero ◽  
...  
Keyword(s):  
Anticoagulation Therapy ◽  
Target Range ◽  
Clotting Time ◽  
Coagulation Time ◽  
Empirically Supported ◽  
Activated Clotting Time ◽  
Heparin Activity ◽  
Venovenous Ecmo ◽  
Activated Coagulation Time ◽  
Heparin Dosage

Purpose: Extra Corporeal Membrane Oxygenation (ECMO) is used in cases of severe respiratory and/or circulatory failure over periods of several days to several weeks. Its circuitry requires a closely monitored anticoagulation therapy that is empirically supported by activated clotting time (ACT)—a method often associated with large inter- and intraindividual variability. We aimed to compare the measurement of heparin activity with ACT and the direct measurement of the heparin activity (anti-Xa) in a large ECMO population. Methods: All patients treated by venoarterial or venovenous ECMO in our intensive care unit between January 2014 and December 2015 were prospectively included. A concomitant measurement of the anti-Xa activity and ACT was performed on the same sample collected twice a day (morning–evening) for unfractionated heparin adaptation with an ACT target range of 180 to 220 seconds. Results: One hundred and nine patients (men 69.7%, median age 54 years) treated with ECMO (70.6% venoarterial) were included. Spearman analysis found no correlation between anti-Xa and ACT (ρ < 0.4) from day 1 and worsened over time. Kappa analysis showed no agreement between the respective target ranges of ACT and anti-Xa. Conclusions: We demonstrate that concomitant measurement of ACT and anti-Xa activity is irrelevant in ECMO patients. Since ACT is poorly correlated with heparin dosage, anti-Xa activity appears to be a more suitable assay for anticoagulation monitoring.

The Effect of Lysed Platelets on Neutralization of Heparin In Vitro with Protamine as Measured by the Activated Coagulation Time (ACT)

1991 ◽  
Vol 66 (02) ◽  
pp. 213-217 ◽  
Author(s):  
Arthur P Bode ◽  
William J Castellani ◽  
Edna D Hodges ◽  
Susan Yelverton
Keyword(s):  
Platelet Rich Plasma ◽  
Coagulation Time ◽  
Platelet Factor ◽  
Platelet Suspension ◽  
Antiheparin Activity ◽  
Unit Increase ◽  
Heparin Anticoagulation ◽  
Heparin Activity ◽  
Activated Coagulation Time

SummaryThe effect of lysed platelets on the activated coagulation time (ACT) was studied in heparinized whole blood during titration with protamine. Frozen-thawed washed platelet suspension, or a chromatography fraction thereof, or autologous frozen-thawed platelet-rich plasma was added in various dilutions to freshly drawn blood anticoagulated with 3,000 USP units/1 heparin. After a 10 min incubation, the amount of protamine needed to restore the ACT to baseline ("protamine titration dose") was determined. We found that the protamine titration dose decreased in proportion to the amount of lysed platelet material added; expressed as a percentage of the total number of platelets present, each unit increase in lysed platelets produced a 1.7% ±0.8 (SD) reduction in the protamine dose needed to normalize the ACT. A heparin activity assay showed that this effect was not due to antiheparin activity of lysed platelets such as platelet factor 4 (PF4). Our data indicate that the procoagulant activity of platelet membranes reduced the sensitivity of the ACT to heparin. These findings suggest that membranous platelet microparticles may cause an inaccurate calculation, based on the ACT, of a protamine dose to reverse heparin anticoagulation in cardiopulmonary bypass procedures.

Variability of Activated Clotting Time by Site of Sample Draw During Percutaneous Coronary Intervention: A Prospective Single-Center Study

Angiology ◽  
2021 ◽  
pp. 000331972199223
Author(s):  
Jacqueline H. Morris ◽  
Junsoo Alex Lee ◽  
Scott McNitt ◽  
Ilan Goldenberg ◽  
Craig R. Narins
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Unfractionated Heparin ◽  
Anticoagulation Therapy ◽  
Coronary Intervention ◽  
Clotting Time ◽  
Access Sheath ◽  
Arterial Blood ◽  
Activated Clotting Time ◽  
Guide Catheter ◽  
Percutaneous Coronary

The activated clotting time (ACT) assay is used to monitor and titrate anticoagulation therapy with unfractionated heparin during percutaneous coronary intervention (PCI). Observations at our institution suggested a considerable difference between ACT values drawn from varying arterial sites, prompting the current study. Patients undergoing PCI with unfractionated heparin therapy were prospectively enrolled. Simultaneous arterial blood samples were drawn from the access sheath and the coronary guide catheter. Differences between Hemochron ACT values were determined, and potential interactions with clinical variables were analyzed. Immediately postprocedure, the simultaneous mean guide and sheath ACTs were 327 ± 62 seconds and 257 ± 44 seconds, respectively, with a mean difference of 70 ± 60 seconds (P < .001). Nearly all (90%) ACT values obtained via the guide catheter were higher than the concurrent ACT drawn from the sheath. Logistic regression analysis demonstrated that lower weight-adjusted heparin doses and absence of diabetes were associated with a greater difference between the ACT values. We conclude that the ACT value is substantially greater when assessed via the guide catheter versus the access sheath. Although the biological mechanisms require further study, this difference should be considered when managing anticoagulation during PCI and when reporting ACT as part of research protocols.

Comparison of Viscoelastometric Assays to Traditional Activated Clotting Time for Assessing Heparin Activity in Whole Blood

2013 ◽  
Vol 179 (2) ◽  
pp. 199
Author(s):  
M.P. Chapman ◽  
E.E. Moore ◽  
T.L. Chin ◽  
A. Ghasabyan ◽  
C.R. Ramos ◽  
...  
Keyword(s):  
Whole Blood ◽  
Clotting Time ◽  
Activated Clotting Time ◽  
Heparin Activity

Conversion From Activated Clotting Time to Anti-Xa Heparin Activity Assay for Heparin Monitoring During Extracorporeal Membrane Oxygenation*

2020 ◽  
Vol 48 (12) ◽  
pp. e1179-e1184 ◽  
Author(s):  
Cristina A. Figueroa Villalba ◽  
Thomas V. Brogan ◽  
D. Michael McMullan ◽  
Larissa Yalon ◽  
D. Ian Jordan ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Activity Assay ◽  
Clotting Time ◽  
Membrane Oxygenation ◽  
Activated Clotting Time ◽  
Heparin Activity ◽  
Heparin Monitoring

Role of Activated Clotting Times in Carotid Stenting with Filter Protection

2003 ◽  
Vol 16 (1) ◽  
pp. 87-91
Author(s):  
L. Castellan ◽  
F. Causin ◽  
V. Pinna ◽  
M. Marchi ◽  
D. Danieli ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Anticoagulation Therapy ◽  
Carotid Stenting ◽  
Statistical Correlation ◽  
Clotting Time ◽  
Activated Clotting Time ◽  
Heparin Anticoagulation ◽  
Distal Protection ◽  
Angiographic Findings

To evaluate the role of anticoagulation therapy in carotid stenting with filter devices, we compared the activated clotting times (ACT) to angiographic filter patency and to the materials found inside the filters. 29 endovascular treatments with filter cerebral protection in 27 patients affected by symptomatic internal carotid stenosis > 70% were considered. Angiographic findings, ACT and histopathologic specimens were recorded and statistically correlated. Satisfactory dilatation of the stenosis was always achieved with a complication rate of 3%. During the procedure nine filters caused temporary flow impairment. Histopathologic examination demonstrated material inside the filters in 86% of cases but this material was fibrin alone in 38% and plaque debris in 48%. Significant statistical correlation (p = 0.009) was found between low activated clotting time and occlusion of the filter. Distal protection filters can collect plaque fragments occurring during carotid stenting. A significant proportion of the debris found in the filters consisted of thrombotic material. Monitoring of heparin anticoagulation is recommended to prevent filter occlusion.

Adjusting Heparin Infusion Rates from the Initial Response to Activated Coagulation Time

1983 ◽  
Vol 17 (9) ◽  
pp. 632-634 ◽  
Author(s):  
Paul G. Hattersley ◽  
J. Chris Mitsuoka ◽  
Robert J. Ignoffo ◽  
Jeffrey H. King ◽  
Nabil A. Musallam
Keyword(s):  
Mathematical Model ◽  
Mathematical Description ◽  
Response Curve ◽  
Initial Response ◽  
Heparin Dose ◽  
Coagulation Time ◽  
Heparin Infusion ◽  
The Mean ◽  
Activated Coagulation Time ◽  
Heparin Dosage

A mathematical description of the dose-response curve of heparin to the activated coagulation time is applied retrospectively to 20 patients treated with continuous heparin infusion. The adjusted heparin dose was compared with a calculated prediction using the theoretical mathematical model. The main actual dose was 28 U/kg/h, and the mean predicted dose was 25.8 U/kg/h. The correlation coefficient was 0.862 (p30.05). These data are used to develop a dosing adjustment chart. Special considerations prior to using the calculation or dosing adjustment chart are discussed. The use of this model may allow the clinician to determine more rapidly a therapeutic heparin dosage than previous empiric approaches.

scholarly journals Evaluation of the TAS Analyzer and the Low-Range Heparin Management Test in Patients Undergoing Extracorporeal Membrane Oxygenation

2001 ◽  
Vol 47 (5) ◽  
pp. 858-866 ◽  
Author(s):  
Theresa M Ambrose ◽  
Curtis A Parvin ◽  
Eric Mendeloff ◽  
Lori Luchtman-Jones
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Management Strategy ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Clotting Time ◽  
Blood Draw ◽  
Membrane Oxygenation ◽  
Activated Clotting Time ◽  
The Relationship ◽  
Heparin Dosage

Abstract Background: The new Low-Range Heparin Management Test (LHMT), a method for point-of-care testing (POCT) of heparinization, has been designed to function at the low to moderate heparin concentrations typically found in patients undergoing extracorporeal membrane oxygenation (ECMO). In this study, the new method is compared with two POCT methods and a laboratory-based anti-Xa assay. Methods: We obtained 760 whole blood samples from 13 patients undergoing ECMO. All samples were tested immediately by the LHMT, the Activated Clotting Time (ACT) test, and its low-range counterpart (ACT-LR). Aliquots from the same blood draw were frozen for later anti-Xa analysis using the Diagnostica Stago method on the Roche Cobas Fara-II. Results: The precision was best for duplicate citrated LHMT samples (CV = 3.1%). LHMT clotting times (overall median, 162 s) were typically shorter than ACT or ACT-LR times (247 and 235 s, respectively). The relationship between the LHMT and the other POCT methods differed significantly from patient to patient (P &lt;0.0001), and a meaningful single relationship between the methods could not be obtained. The overall correlation coefficient between clotting time values and actual heparin concentrations was ≤0.48 for each of the instruments tested, although time plots of each analyzer’s data suggested that they detected heparin dosage changes within single patients. Conclusions: The performance of the LHMT on the TAS Analyzer is equivalent to that of currently commercially available POCT methods. The lack of agreement between absolute clotting time values and heparin concentrations suggests the need for reexamination of current ECMO patient management strategy.

Sign in / Sign up

Export Citation Format

Share Document