scholarly journals Activated coagulation time vs. intrinsically activated modified rotational thromboelastometry in assessment of hemostatic disturbances and blood loss after protamine administration in elective cardiac surgery: analysis from the clinical trial (NCT01281397)

2014 ◽  
Vol 9 (1) ◽  
Author(s):  
Mate Petricevic ◽  
Bojan Biocina ◽  
Davor Milicic ◽  
Lucija Svetina ◽  
Marko Boban ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Blood Loss ◽  
Coagulation Time ◽  
Rotational Thromboelastometry ◽  
Elective Cardiac Surgery ◽  
Activated Coagulation Time ◽  
Protamine Administration

High Molecular Weight Kininogen Deficiency: a Patient who Underwent Cardiac Surgery

2001 ◽  
Vol 85 (02) ◽  
pp. 195-197 ◽  
Author(s):  
J. F. Burman ◽  
L. C. Rutherford ◽  
B. F. Keogh ◽  
M. H. Yacoub ◽  
S. J. Davidson
Keyword(s):  
Molecular Weight ◽  
Cardiac Surgery ◽  
High Molecular Weight ◽  
High Molecular Weight Kininogen ◽  
Coagulation Time ◽  
Chromogenic Assay ◽  
Thrombotic Complications ◽  
Pulmonary Bypass ◽  
Activated Coagulation Time ◽  
Protamine Administration

SummaryA 66 year old male, referred for cardiac surgery, was found to have high molecular weight kininogen deficiency (activity <1%). Apart from activated partial thromboplastin time (APTT) >300 s, tests of haemostasis were otherwise normal (factors VIII, IX, XI, XII and prekallikrein). No inhibitor of coagulation was found.The activated coagulation time (ACT) was 800 s pre-operatively and >1000 s after heparin. Heparin levels were measured directly by an anti-Xa chromogenic assay, with values of between 2.9 and 3.2 u/ml during cardiopulmonary bypass. Thrombin-antithrombin levels rose from 2.3*g/l before surgery to a peak of 83.5*g/l at the end of cardio-pulmonary bypass. Cross linked fibrin d-dimers (XDP) levels rose from 100 ng/ml before operation to 600 ng/ml after protamine administration. The patient had no excess bleeding and no thrombotic complications from surgery.This patient shows that high molecular weight kininogen is not required for thrombin formation or fibrinolysis during cardiac surgery and illustrates the need to measure heparin directly in patients with such contact factor deficiencies.

In Vivo Protamine Titration Using Activated Coagulation Time to Neutralize Heparin Anticoagulation in Cardiac Surgery: Proof of Concept

2020 ◽  
Vol 34 (9) ◽  
pp. 2369-2374
Author(s):  
Antoine G. Rochon ◽  
Sylvain Bélisle ◽  
Pierre Couture ◽  
Annik Fortier ◽  
Jean-Sébastien Lebon ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Proof Of Concept ◽  
Coagulation Time ◽  
Heparin Anticoagulation ◽  
Activated Coagulation Time

scholarly journals Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

2020 ◽  
Vol 68 (8) ◽  
pp. 754-761
Author(s):  
Hayato Ise ◽  
Hiroto Kitahara ◽  
Kyohei Oyama ◽  
Keiya Takahashi ◽  
Hirotsugu Kanda ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Circulatory Arrest ◽  
Operation Time ◽  
Hypothermic Circulatory Arrest ◽  
Anesthesia Induction ◽  
Rotational Thromboelastometry ◽  
Elective Cardiac Surgery ◽  
Group 12 ◽  
Perioperative Bleeding ◽  
Before And After

Abstract Objectives Hypothermic circulatory arrest (HCA) has been considered to cause coagulopathy during cardiac surgery. However, coagulopathy associated with HCA has not been understood clearly in details. The objective of this study is to analyze the details of coagulopathy related to HCA in cardiac surgery by using rotational thromboelastometry (ROTEM). Methods We retrospectively analyzed 38 patients who underwent elective cardiac surgery (HCA group = 12, non-HCA group = 26) in our hospital. Blood samples were collected before and after cardiopulmonary bypass (CPB). Standard laboratory tests (SLTs) and ROTEM were performed. We performed four ROTEM assays (EXTEM, INTEM, HEPTEM and FIBTEM) and analyzed the following ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF) and maximum clot elasticity (MCE). The amount of perioperative bleeding, intraoperative transfusion and perioperative data were compared between the HCA and non-HCA group. Results Operation time and hemostatic time were significantly longer in the HCA group, whereas CPB time had no difference between the groups. The amount of perioperative bleeding and intraoperative transfusion were much higher in the HCA group. SLTs showed no difference between the groups both after anesthesia induction and after protamine reversal. In ROTEM analysis, MCE contributed by platelet was reduced in the HCA group, whereas MCE contributed by fibrinogen had no difference. Conclusion Our study confirmed that the amount of perioperative bleeding and intraoperative transfusion were significantly higher in the HCA group. ROTEM analysis would indicate that clot firmness contributed by platelet component is reduced by HCA in cardiac surgery.

Use of Activated Coagulation Time to Monitor Heparin during Cardiac Surgery

1979 ◽  
Vol 28 (1) ◽  
pp. 69-72 ◽  
Author(s):  
Jack A. Roth ◽  
Ramon A. Cukingnan ◽  
Calvin R. Scott
Keyword(s):  
Cardiac Surgery ◽  
Coagulation Time ◽  
Activated Coagulation Time

Arterial versus venous sampling for activated coagulation time measurements during cardiac surgery: A comparative study

2004 ◽  
Vol 18 (5) ◽  
pp. 573-580 ◽  
Author(s):  
Galina Leyvi ◽  
Ilya Zhuravlev ◽  
Asuquo Inyang ◽  
Joselito Vinluan ◽  
Sujatha Ramachandran ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Comparative Study ◽  
Venous Sampling ◽  
Coagulation Time ◽  
Activated Coagulation Time

Efficacy of a Simple Intraoperative Transfusion Algorithm for Nonerythrocyte Component Utilization after Cardiopulmonary Bypass

2001 ◽  
Vol 94 (5) ◽  
pp. 773-781 ◽  
Author(s):  
Gregory A. Nuttall ◽  
William C. Oliver ◽  
Paula J. Santrach ◽  
Sandra Bryant ◽  
Joseph A. Dearani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Operating Room ◽  
Prospective Trial ◽  
Median Number ◽  
Control Group ◽  
Coagulation Test ◽  
Elective Cardiac Surgery ◽  
Abnormal Bleeding

Background Abnormal bleeding after cardiopulmonary bypass (CPB) is a common complication of cardiac surgery, with important health and economic consequences. Coagulation test-based algorithms may reduce transfusion of non-erythrocyte allogeneic blood in patients with abnormal bleeding. Methods The authors performed a randomized prospective trial comparing allogeneic transfusion practices in 92 adult patients with abnormal bleeding after CPB. Patients with abnormal bleeding were randomized to one of two groups: a control group following individual anesthesiologist's transfusion practices and a protocol group using a transfusion algorithm guided by coagulation tests. Results Among 836 eligible patients having all types of elective cardiac surgery requiring CPB, 92 patients developed abnormal bleeding after CPB (incidence, 11%). The transfusion algorithm group received less allogeneic fresh frozen plasma in the operating room after CPB (median, 0 units; range, 0-7 units) than the control group (median, 3 units; range, 0-10 units) (P = 0.0002). The median number of platelet units transfused in the operating room after CPB was 4 (range, 0-12) in the algorithm group compared with 6 (range, 0-18) in the control group (P = 0.0001). Intensive care unit (ICU) mediastinal blood loss was significantly less in the algorithm group. Multivariate analysis demonstrated that transfusion algorithm use resulted in reduced ICU blood loss. The control group also had a significantly greater incidence of surgical reoperation of the mediastinum for bleeding (11.8% vs. 0%; P = 0.032). Conclusions Use of a coagulation test-based transfusion algorithm in cardiac surgery patients with abnormal bleeding after CPB reduced non-erythrocyte allogeneic transfusions in the operating room and ICU blood loss.

scholarly journals Impact of tranexamic acid on coagulation parameters in patients undergoing total knee replacement surgeries under tourniquet: an observational study

2018 ◽  
Vol 6 (4) ◽  
pp. 1144
Author(s):  
Ajit Kumar Singh ◽  
Gagan Kumar Narula ◽  
Bala Chandran Nambiar ◽  
Parvinder Singh Bedi ◽  
Deeparani S. ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Platelet Function ◽  
P Value ◽  
Coagulation Time ◽  
Coagulation Parameters ◽  
Total Knee ◽  
Activated Coagulation Time

Background: A growing body of evidence has shown Tranexamic Acid (TXA) is effective in decreasing perioperative blood loss and transfusion requirements in both primary and revision joint arthroplasty. TXA is a synthetic drug which limits blood loss through inhibition of fibrinolysis and clot degradation. It helps reduce requirement of colloids and crystalloids and hence provides better haemodynamic stability. The aim of this study was to detect the effect of tranexamic acid on coagulation parameters and effect on bleeding in knee replacement surgeries performed under tourniquet.Methods: Patients undergone surgeries of Total Knee Replacement (TKR) performed under tourniquet were included in the study. A single dosage of 20 mg/kg per body weight of tranexamic acid was administered after application of a tourniquet. Three times blood sample was collected, and coagulation parameters were recorded and compared. The first sample was collected at the time of TXA injection and application of a tourniquet, second after 4 hours and third after 24 hours post TXA injection. Coagulation parameters noted were analyzed using Statistical analysis by SPSS software. All parameters were compared in relation to baseline i.e. at the time of TXA injection.Results: On comparison of demographic profile, morbidity, sofa score and hemodynamic parameters there was the insignificant difference (P > 0.05). Repeated measures of ANOVA at 95% Confidential Interval P value was 0.000 which is less than the significant level that is 0.05 so that value of Platelet Function (PF), Activated Coagulation Time (ACT) and Clot Rate (CR) at 0 hrs, 04 hrs and 24 hrs was statistically significant. Correlation between blood loss and difference of the value of ACT at 0 hrs and 04 hrs is a small negative correlation but statistically nonsignificant (P value is 0.359).Conclusions: After TXA administration there is a change in coagulation parameters like an Activated Coagulation Time (ACT), Platelet Function (PF), and Clot Rate (CR) measured at three intervals, hence it can be a guide to detect early derangement in the coagulation profile in a patient undergoing knee replace surgery. TXA correlation between blood loss with changes in parameters of coagulation i.e. ACT, PF and CR were noted but not significant.

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