Anticoagulation monitoring during extracorporeal circulation with the Hepcon/HMS device

Abstract

During cardiac surgery under CPB, heparin and protamine titration with the Hepcon/HMS device could predict a lower protamine dose and lower postoperative bleeding without higher thromboembolic events, and lower perioperative red blood cell transfusion with a shorter chest closure time.

Anticoagulant and side-effects of protamine in cardiac surgery: a narrative review

“…112 In half of the studies, a reduction in the protamine-to-heparin dosing ratio was associated with improved haemostatic test results 26,101,102,108 or less postoperative bleeding. 79,103,104,111,112 One group showed no difference in 12 h blood loss between the fixed protamine-dose and protamine-titration groups [median 495 (range 150e1460) vs median 475 (range 300e1070) ml, respectively; P¼0.81], but this can be explained by almost similar protamine-to-heparin dosing ratios in both groups [0.84 (0.14) vs 0.86 (0.19); P¼0.57]. 99 Others reported no difference in postoperative blood loss when an ACT and protaminetitration strategy were compared.…”

2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery

“…In most studies, this situation is associated with decreased blood loss and transfusion requirements as well as with higher platelet counts at the end of the operation. 150,151,153,[158][159][160] In contrast, others did not show favourable results for blood loss and transfusion requirements when heparin titration was compared with an ACT-based protocol. 152,[161][162][163] Due to the lack of perioperative bleeding and transfusion rates as primary end points in these studies, larger multicentre RCTs are required to determine the added value of individual heparin management.…”

Anticoagulation management during multivessel coronary artery bypass grafting: a randomized trial comparing individualized heparin management and conventional hemostasis management

“…This meta-analysis included the largest study of this topic to date, with 254 patients, by Despotis et al [10], which concluded that IHM reduces blood product utilization. However, this study encompassed different cardiac surgery procedures, including short and much longer combined operations, and used different ACT procedures in the treatment and control groups (IHM, kaolin; CHM, celite) to verify the target ACT of 480 s. More recently, a study demonstrated higher blood loss in CHM patients [11], whereas Slight et al [12] reported no differences in hemostatic markers, blood loss, or blood transfusions. Another study investigated correlations between calculated heparin concentrations and the resulting ACT values, and concluded that IHM failed to predict the heparin bolus dose required to achieve a given target ACT precisely [13].…”

“…, which concluded that IHM reduces blood product utilization. However, this study encompassed different cardiac surgery procedures, including short and much longer combined operations, and used different ACT procedures in the treatment and control groups (IHM, kaolin; CHM, celite) to verify the target ACT of 480 s. More recently, a study demonstrated higher blood loss in CHM patients , whereas Slight et al . reported no differences in hemostatic markers, blood loss, or blood transfusions.…”