ACT 2018 – Lessons to be learned from the past

Abstract

In this review we summarize the current status of knowledge and outline future directions regarding the use of activated clotting time devices (ACT) for heparin monitoring.It is over 50 years ago that Paul Hattersley first described the ACT and 40 years ago it was first used as a simple method of heparin management during extracorporeal circulation. Today, ACT is the primary test for monitoring heparin activity in cardiac and vascular operating rooms, intensive care and hemodialysis units as well as in the catheter lab. Without appropriate anticoagulation clot will start to form during these procedures, with a high chance of a fatal event occurring. Currently, there are several POC methods available for ACT measurement, however results obtained with different devices can vary substantially. Furthermore, the target ACTs which are described in guidelines are mostly empiric or based on small-scale studies done with one or different POC ACT devices. Moreover, it is important to realize that there is no "gold standard" ACT method and therefore no "true" ACT. The ACT has gone unchallenged for a long time. Being mostly 'clinician owned' we have come to accept that, in the absence of a gold standard, there is no way to determine if any one of the commercially available devices measures a true ACT value. The lesson to be learned from the last 40 years is that clinicians', laboratory staff 's and manufacturers' approach to the ACT needs to become more collaborative, open and truly multidisciplinary in order to stand up to the level of scrutiny that is increasingly demanded in modern healthcare.

Heparin Dosing During Percutaneous Coronary Intervention and Obesity

“…3 The Hemochron and Hemotec devices were used in the early era of PCI trials, and guidelines refer to these devices in dosing recommendations, but point-of-care devices by other manufacturers are increasingly used in clinical practice. 11 The Hemochron ACT assay has slightly longer reaction times than the Hemotec assay, and targets vary for both in the clinical practice guidelines. The Abbott i-STAT ACT has similar calibration to the Hemotec assay and the target ACT in guidelines are the same.…”