scholarly journals Safety of a single bolus administration of heparin without the measurement of activated clotting time during cryoballoon ablation: a prospective randomized controlled trial

2021 ◽  
Author(s):  
Dong Geum Shin ◽  
Jinhee Ahn ◽  
Sang-Jin Han ◽  
Hong Euy Lim
Keyword(s):  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Bleeding Complications ◽  
Cryoballoon Ablation ◽  
Bolus Administration ◽  
Single Shot ◽  
Clotting Time ◽  
Single Bolus ◽  
Activated Clotting Time ◽  
Group A

Introduction: Single-shot ablation has emerged as an effective technique for index atrial fibrillation (AF) ablation, with an advantage of short procedure time. Although recent guidelines recommend peri-procedural uninterrupted oral anticoagulants (OACs), the intra-procedural anticoagulation strategy remains uncertain under non-vitamin K OACs (NOACs). We investigated procedural safety of a single bolus administration of heparin without activated clotting time (ACT) measurement during cryoballoon ablation (CBA). Methods: Two hundred patients (64.2±10.0years, 70% with non-paroxysmal AF) who underwent CBA with uninterrupted NOACs were randomly assigned to No-ACT group and ACT group. A bolus of heparin (100 U/kg) was routinely administered immediately after transseptal puncture. In the ACT group, an additional injection of heparin (30 U/kg) was administered if ACT at 30-min after the initial bolus was <300 s. Results: There were no differences in baseline characteristics including CHA2DS2-VASc score between two groups. The left atrium indwelling and procedure times were 60.4±13.1 min and 78.9±13.9 min, respectively and not significantly different between two groups. The mean ACT was 335.2±59.9 s in the ACT group. Any bleeding rate was 3.2% in all patients and there was no statistically difference in bleeding complications between two groups. In the ACT group, groin hematoma, laryngopharyngeal bleeding, and hemoptysis occurred in 3, 1, and 1 patient, respectively. Cardiac tamponade occurred in 1 patient in the No-ACT group. No thromboembolic events occurred during the 30-day follow-up after CBA. Conclusion: Single bolus administration of heparin without ACT measurement is a feasible anticoagulation strategy for CBA in patients with uninterrupted NOACs intake.

Extracorporeal Lung Assist with Heparin-Coated Systems

1992 ◽  
Vol 15 (1) ◽  
pp. 29-34 ◽  
Author(s):  
R. Rossaint ◽  
K. Slama ◽  
K. Lewandowski ◽  
R. Streich ◽  
P. Henin ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Safety Margin ◽  
Bleeding Complications ◽  
Major Surgery ◽  
Clotting Time ◽  
Normal Range ◽  
Extracorporeal Lung Assist ◽  
Activated Clotting Time ◽  
Extracorporeal Gas Exchange ◽  
Extracorporeal Support

Extracorporeal lung assist (ELA) has been recommended for the treatment of ARDS if conventional therapy fails. However, the need for nearly complete anticoagulation is a major risk factor for hemorrhagic complications. We describe our experience with 13 ARDS patients treated with ELA using heparin-coated systems (Carmeda). Maintaining partial thromboplastin time and activated clotting time within or close to the normal range, even major surgery (20 thoracotomies and 2 laparotomies) could be performed without undue bleeding complications related to anticoagulation during extracorporeal support. Eight of the 13 patients survived. The use of heparin-coated systems allows prolonged ELA with nearly physiological coagulation function, permitting major surgical intervention. It enhances the safety margin of extracorporeal gas exchange and may ultimately extend its indications.

Prothrombinase Induced Clotting Time (PICT) and Commercially Available Diluted Russell's Viper Venom Times For The Monitoring Of New Oral Anticoagulants

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3642-3642
Author(s):  
Debra Hoppensteadt ◽  
Jeanine M. Walenga ◽  
Josephine Cunanan ◽  
Omer Iqbal ◽  
Jawed Fareed
Keyword(s):  
Conflicts Of Interest ◽  
Platelet Rich Plasma ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Bleeding Complications ◽  
Clotting Time ◽  
R And D ◽  
One Stage ◽  
Russell’S Viper ◽  
The One

Abstract The new oral anticoagulants such as Rivaroxaban (Bayer Healthcare) (R) Apixaban (BMS/Pfizer) (A) and Dabigatran (Boehringer Ingleheim) (D) have been approved for Several indications in the US and Europe. Initially it was suggested that these agents did not require monitoring at the approved dosages for specific indications, however there have been reported bleeding complications with some of these agents that warrants the monitoring of these drugs to optimize therapy in some patient populations. A new clot-based assay, the prothrombinase induced clotting time (PICT) (Pentapharm, Basal, Switzerland) has been developed to monitor the anticoagulant effect of these new oral anticoagulants. In the assay, plasma is mixed with FXa, phospholipids, calcium and RVV-V from the venom of the Daboia russelli. The prothrombinase complex formed and the Xa and IIa generated is inhibited by the test agent. Two other forms of diluted Russell's Viper Venom time, namely DRVVT (screen), and DRVVT (confirm) are also available for the laboratory diagnosis of the lupus anticoagulant. The purpose of this study is to compare the PICT teste with the two versions of DRVVT test times for the monitoring of newer anticoagulants. Materials Citrated blood was drawn from 15 donors and spun at 800 rpm to obtain platelet rich plasma (PRP). The PRP was removed and spun at 3000 rpm to obtain platelet poor plasma (PPP). Both PRPand PPP were frozen at -80ºC for 24 hours. Thawed PPP and PRP were supplemented with A, R and D in a concentration range of 0-2.5 ug/ml. The plasma samples were analyzed using 3 PT/INR reagents (Innoven, Dade-Behring, Germany; Recombiplastin, Instrumentation Laboratories, Bedford, MA; Neoplastin, Stago, Parsippany, NJ), two APTT reagents (Platelin, TCoag, Ireland; Actin FSL, Instrumentation Laboratories, Bedford, MA), Heptest, the one stage PICT and the two versions of DRVVT. All assays were performed on the ACL 300 Plus (Instrumentation Laboratories, Bedford, MA) with the exception of the PICT and DRVVTs which were run on the ST4 (STago, Parsippany, NJ). Results In the PPP system, the A, R and D showed assay differences in the clotting times which demonstrated good sensitivity to D and R compared to A. The PICT and the two versions of DRVVT showed much higher sensitivity and linearity. The relative sensitivity to DRVVTs were higher than PICT. In the PT/INR assay, all reagents were sensitive to D and the Innovin and recombiplastin were sensitive to R and showed a weaker response to A. Similar responses were observed in the APTT and Heptest assay. In the PICT and DRVVTs, all drugs showed a concentration dependent increase. D was strongest followed by R, and A showed the weakest effect. In the PRP supplemented system, all agents showed a weaker effect on the clotting times in all tests, however PICT and DRVVTs demonstrated a concentration dependent response for all agents. Conclusions These results demonstrated that neither the PT/INR, APTT nor heptest can be solely used to monitor the effects of all of the new oral anticoagulants. The one stage PICT is a simple, fast, automated or semi-automated test which can be performed on any mechanical or optical coagulation analyzer to monitor the anticoagulant effects of these agents. Similarly the two versions of DRVVT can also be performed on these instruments. The one stage PICT and DRVVT tests can also be used to monitor the effects of these agents in other matrices such as PRP. These studies warrant clinical validation of this test in patients treated with the newer oral anticoagulant drugs. Disclosures: No relevant conflicts of interest to declare.

Clinical and Experimental Evaluation of the Interaction of Anticoagulant Drugs with Radiologic Contrast Media

1979 ◽  
Author(s):  
R. Moncada ◽  
H. L. Messmore ◽  
J. Fareed ◽  
P. J. Scanlon ◽  
Z. Parvez
Keyword(s):  
Contrast Media ◽  
Media Studies ◽  
Oral Anticoagulants ◽  
Thrombin Time ◽  
Clotting Time ◽  
Activated Clotting Time ◽  
Anticoagulant Action ◽  
Human Volunteers ◽  
Anticoagulant Drugs ◽  
Vascular Angiography

Although clinical incompatibilities of antihistamines and protamine with radiologic contrast media are well recognized, no report is available on the interaction of heparin, Coumadin, dextrans and other anticoagulants with these agents. We have employed the automated activated clotting time (ACT), prothrombin time (FT), partial thromboplastin time (PTT) and the thrombin time (TT) methods to monitor the anticoagulant actions of contrast media and its interaction with various anticoagulant drugs in patients undergoing angiography, A strong synergism of the anticoagulant action of heparin was observed in patients given heparin along with contrast media. Studies conducted in human volunteers revealed that contrast media at a 1-5 mg/ml level (clinical, 0.5-0.6 mg/ml) produce a strong synergistic effect on the anticoagulant action of heparin, oral anticoagulants, dextrans, and antiplatelet drugs. When blood obtained from patients undergoing angiography was supplemented with 0.25 u/ml heparin, the ACT, PTT and TT were equal to 1.5-2.0 units of heparin. Conventional amounts of protamine are incapable of neutralizing this synergistic interaction. These studies show that contrast media temporarily augments the degree of anticoagulation in patients undergoing angiography, which should be taken into consideration in patients undergoing vascular angiography.

scholarly journals CAUDAL ANALGESIA IN CHILDREN;

2012 ◽  
Vol 19 (05) ◽  
pp. 715-718
Author(s):  
MUHAMMAD AMER ◽  
MUHAMMAD SAIF UL MALOOK ◽  
MUHAMMAD SHER UZ ZAMAN
Keyword(s):  
Postoperative Period ◽  
Controlled Trial ◽  
Analgesic Efficacy ◽  
Nausea And Vomiting ◽  
Single Shot ◽  
Rescue Analgesia ◽  
Caudal Analgesia ◽  
Group A ◽  
Analgesic Technique ◽  
Group B

Background: Caudal analgesia with bupivacaine is used commonly for pain relief in children and extradural administration oftramadol seems to be a safe method of analgesia. The aim of the study was to compare the analgesic efficacy of caudal bupivacaine andbupivacaine and tramadol mixture for postoperative analgesia and to observe for the side effects. Setting: Department of Anesthesia andIntensive Care Unit, Bahawal Victoria Hospital, Bahawalpur. Period: 01-12-2010 to 30-11-2011. Methods: Eighty children, aged between 2 to12 years of age undergoing infra umbilical surgeries were selected for this randomized, controlled trial. They were randomly divided into twogroups A and B. Group A (n = 40) received 0.5 ml/kg of 0.25 % bupivacaine and Group B (n = 40) received 0.5 ml/kg of 0.25 % bupivacaine with 1mg/kg of tramadol as a single shot caudal block. In the postoperative period, duration of analgesia, pain score, nausea, vomiting and sideeffects were noted and analyzed. Results: Patients in both groups were comparable for age and weight. It was observed that the meanduration of analgesia in group A patients was 6.23+0.68 hours while in group B, it was 9.33+0.72 hours (p<0.05). Nausea and vomiting waspresent in 20% (n=8) patients in group A, while in group B, 27.5% (n=11) had nausea and vomiting in the post operative period (p<0.05). None ofthe patients in both the groups had complications like motor weakness, urinary retention in the postoperative period. Conclusions: Theaddition of tramadol to bupivacaine in the caudal analgesic technique provides longer analgesia and lesser need for rescue analgesia in thepostoperative period compared to bupivacaine alone.

scholarly journals Comparison of bolus administration effects of lidocaine on preventing tourniquet-induced hypertension in patients undergoing general anesthesia: a randomized controlled trial

2021 ◽  
Author(s):  
Ji WooK Kim ◽  
A Ran Lee ◽  
Eun Sun Park ◽  
Min Su Yun ◽  
Sung Won Ryu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Controlled Trial ◽  
Control Group ◽  
Double Blind Study ◽  
Bolus Administration ◽  
Double Blind ◽  
Single Bolus ◽  
Randomized Controlled ◽  
Induced Hypertension ◽  
Tourniquet Inflation

Background: This study assessed the effect of a single bolus administration of lidocaine on the prevention of tourniquet-induced hypertension (TIH) and compared the effect of lidocaine to that of ketamine in patients undergoing general anesthesia.Methods: This randomized, controlled, double-blind study included 75 patients who underwent lower limb surgery using a tourniquet. The patients were administered lidocaine (1.5 mg/kg, n = 25), ketamine (0.2 mg/kg, n = 25) or placebo (n = 25). The study drugs were administered intravenously 10 min before tourniquet inflation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured before tourniquet inflation, after tourniquet inflation for 60 min at 10 min intervals, and immediately after tourniquet deflation. The incidence of TIH, defined as an increase of 30% or more in SBP or DBP during tourniquet inflation, was also recorded.Results: SBP, DBP, and HR increased significantly over time in the control group compared to those in the lidocaine and ketamine groups for 60 min after tourniquet inflation (P < 0.001, P < 0.001, and P = 0.007, respectively). The incidence of TIH was significantly lower in the lidocaine (n = 4, 16%) and ketamine (n = 3, 12%) group than in the control group (n = 14, 56%) (P = 0.001). Conclusion: Single-bolus lidocaine effectively attenuated blood pressure increase due to tourniquet inflation, with an effect comparable to that of bolus ketamine.

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.

Influence of High-dose Aprotinin on Anticoagulation, Heparin Requirement, and Celite- and Kaolin-Activated Clotting Time in Heparin-pretreated Patients Undergoing Open-Heart Surgery

1995 ◽  
Vol 83 (4) ◽  
pp. 679-689. ◽  
Author(s):  
W. Dietrich ◽  
G. Dilthey ◽  
M. Spannagl ◽  
M. Jochum ◽  
S. L. Braun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Thrombin Generation ◽  
Plasma Concentrations ◽  
Postoperative Blood Loss ◽  
High Dose ◽  
Clotting Time ◽  
Activated Clotting Time ◽  
High Dose Aprotinin ◽  
Group A ◽  
Fibrin Monomers

Background Aprotinin causes a prolongation of the celite-activated clotting time (CACT), but not of the kaolin-activated clotting time (KACT). Therefore, concern has been raised regarding the reliability of CACT to monitor anticoagulation in the presence of aprotinin. The current study was designed to test the efficacy of aprotinin to improve anticoagulation, and to investigate whether the prolongation of CACT reflects true anticoagulation or is an in vitro artifact. To elucidate this antithrombotic effect of aprotinin, this study was done in patients prone to reduced intraoperative heparin sensitivity. Methods In a prospective, randomized, double-blind clinical trial, 30 male patients scheduled for elective primary coronary revascularization and treated with heparin for at least 10 days preoperatively, received either high-dose aprotinin (group A) or placebo (group C). The CACT and KACT were determined, but only CACT was used to control anticoagulation with heparin. Parameters of coagulation that are indicators of thrombin generation and activity (F1+2 prothrombin fragments, thrombin-antithrombin III complex, and fibrin monomers), parameters of fibrinolysis (D-dimers), aprotinin, and heparin plasma concentrations were measured. Postoperative blood loss and allogeneic blood transfused were recorded. Results Total heparin administered was 36,200 units (95% confidence interval: 31,400-41,000; group C) compared with 27,700 (25,500-29,800) units (group A; P &lt; 0.05). Hemostatic activation during cardiopulmonary bypass (CPB) was significantly reduced in group A compared with group C. After 60 min of CPB, all parameters were significantly different (P &lt; 0.05) between the groups (group C vs. group A): F1+2 prothrombin fragments, 9.7 (8.9-11.7) ng/ml versus 7.5 (6.2-8.6) ng/ml; thrombin-anti-thrombin III complex (TAT), 53 (42-68) ng/ml versus 29 (23-38) ng/ml; and fibrin monomers, 23 (12-43) ng/ml versus 8 (3-17) ng/ml. Fibrinolysis was also attenuated; D-dimers at the end of operation were 656 (396-1,089) and 2,710 (1,811-4,055) ng/ml for groups A and C, respectively (P &lt; 0.05). The CACT 5 min after the onset of CPB was 552 (485-627) versus 869 (793-955) s for groups C and A, respectively (P &lt; 0.05), whereas the KACT showed no differences between the groups (569 [481-675] vs. 614 [541-697] s for groups C and A, respectively; P = NS). The 24-h blood loss was 1,496 (1,125-1,995) versus 597 (448-794) ml for groups C and A, respectively (P &lt; 0.05). Conclusions Aprotinin treatment in combination with heparin leads to less thrombin generation during CPB. Aprotinin has anticoagulant properties. Celite-activated ACT is reliable for monitoring anticoagulation in the presence of aprotinin, because the prolonged CACT in the aprotinin group reflects improved anticoagulation. Kaolin-activated ACT does not reflect this effect of aprotinin.

Relationship between activated clotting time during percutaneous intervention and subsequent bleeding complications

2002 ◽  
Vol 144 (3) ◽  
pp. 501-507 ◽  
Author(s):  
William B. Hillegass ◽  
Brigitta C. Brott ◽  
Gregory D. Chapman ◽  
Harry R. Phillips ◽  
Richard S. Stack ◽  
...  
Keyword(s):  
Percutaneous Intervention ◽  
Bleeding Complications ◽  
Clotting Time ◽  
Activated Clotting Time
Sign in / Sign up

Export Citation Format

Share Document