Anticoagulation monitoring during vascular surgery: accuracy of the Hemochron ® low range activated clotting time (ACT-LR)

Tremey, Benjamin; Szekély, Barbara; Schlumberger, S.; François, Dominique; Liu, N.; Sievert, K.; Fischler, Marc

doi:10.1093/bja/ael194

Cited by 23 publications

(13 citation statements)

References 31 publications

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“…Correction for hematocrit altered the correlations; however the changes were slight most likely due to the exclusion of significantly anemic or polycythemic subjects from the population. The correlation of ACT-LR with anti-Xa levels in adult CCL decreases significantly when anti-Xa is greater than 1.0 IU/ml [24]. The anti-Xa activity levels resulting from UFH dosing in our CCL frequently exceeds 1.0 IU/ml (median 1.3) thus exceeding the intended range of the ACT-LR.…”

Section: Discussionmentioning

confidence: 76%

Monitoring unfractionated heparin in pediatric patients with congenital heart disease having cardiac catheterization or cardiac surgery

Kim

Rouby²,

Thompson

et al. 2009

J Thromb Thrombolysis

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Determine the effect of age and congenital heart disease (CHD) on whole blood tests for monitoring unfractionated heparin (UFH) in children. Determine correlation with anti-Xa levels in children undergoing cardiac catheterization or cardiac surgery. A prospective cross-sectional study of 211 healthy children about to have minor surgery (median age 3.5 years) and 110 CHD patients (median age 2.1 years) undergoing cardiac catheterization or cardiac surgery. Commonly used whole blood tests (two activated clotting times and an activated partial thromboplastin time; ACT+, ACT-LR, and APTT, respectively) were obtained before procedures and after UFH in CHD patients. Data were analyzed for effect of age and CHD and correlation with anti-Xa levels. In healthy subjects the ACT+ was lower in younger (<3 years) patients while the ACT-LR and APTT were unaffected. CHD patients exhibited an opposite trend with higher values in the younger patients. After bolus heparin the ACT+ exhibited the strongest correlation (r = 0.89) with anti-Xa levels in both locations (the APTT was too sensitive at post-bolus levels). When anti-Xa levels were below 1.0 IU/ml (range of thromboembolism therapy 0.35-0.7 IU/ml), the APTT correlation coefficient was 0.72. Some whole blood coagulation tests are affected by age in healthy children similar to laboratory tests and are variably influenced by the presence of CHD. ACT+ is the most reliable predictor of anti-Xa levels in both catheterization and surgery for pediatric patients. The APTT exhibited stronger correlation with anti-Xa than previous reports of laboratory APTT and warrants further evaluation for monitoring heparin thromboembolism therapy.

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Section: Discussionmentioning

confidence: 76%

Monitoring unfractionated heparin in pediatric patients with congenital heart disease having cardiac catheterization or cardiac surgery

Kim

Rouby²,

Thompson

et al. 2009

J Thromb Thrombolysis

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“…We showed that a strategy based on DOAC interruption that ensures undetectable DOAC concentration at the time of AF catheter ablation still resulted in a highly interindividual variability in UFH response, with a poor correlation between UFH dose and ACT levels and fewer than two‐thirds of the patients achieving ACT ≥300 seconds during the procedure. Indeed, ACT is accurate for monitoring UFH effects, as a strong and reproducible correlation between ACT and UFH anti‐Xa activity was repeatedly reported . However, several factors affect the anticoagulant response to fixed or weight‐adjusted UFH dose .…”

Section: Discussionmentioning

confidence: 99%

Periprocedural management of anticoagulation for atrial fibrillation catheter ablation in direct oral anticoagulant–treated patients

Lessire

Leblanc

Dincq

et al. 2018

Clinical Cardiology

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Our data showed that uninterrupted DOAC therapy resulted in an unpredictable and highly variable initial level of anticoagulation before catheter ablation. Moreover, even with DOAC interruption preventing interference between DOAC, UFH, and ACT, intraprocedural UFH monitoring was complex. Altogether, our exploratory results call into question the appropriateness of transposing UFH dose protocols, as well as the relevance of ACT monitoring in uninterrupted DOAC-treated patients.

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“…Racioppi et al have recently compared ACT-LR (Hemochron jr II Signature device) with APTT and have concluded that the poor correlation between ACT-LR and APTT does not support routine use of this device [19]. The same device was evaluated by Tremey et al in vascular surgery and was compared to anti-Xa activity [6]. They demonstrated the accuracy of the device, during vascular surgery, with the use of 50 UI·kg -1 UFH.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the ACT has been used for several decades in cardiac surgery as well as other procedures, and now in interventional neuroradiology [5][6][7]. Some controversies remain about the correlation between the different ACT monitoring devices and APTT [8].…”

Section: Introductionmentioning

confidence: 99%

Correlation Between Activated Clotting Time and Activated Partial Thromboplastin Time During Endovascular Treatment of Cerebral Aneurysms

Faraoni¹,

Mine²,

Nabhan³

et al. 2013

Point of Care: The Journal of Near-Patient Testing &Amp; Technology

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Purpose: Endovascular treatment (EVT) of intracranial aneurysms (IA) requires a continuous anticoagulation to avoid thromboembolic complications. In order to monitor the anticoagulation, different tests may be used including the activated clotting time (ACT) and the activated partial thromboplastin time (APTT). The aim of this study was to compare ACT and APTT for the monitoring of the anticoagulation during EVT of IA. Methods: Patients referred for EVT of an IA were included. After induction, baseline ACT and APTT were recorded, followed by a bolus infusion of unfractionated heparin (50 UI·kg -1 ). The same tests were controlled five minutes later with the purpose of doubling the baseline ACT value. Correlation and agreement between both tests were evaluated for the percentage of change after the bolus. Multiple linear regressions were also calculated in order to show confounding factors. Complications and outcomes were also recorded. Results: 45 patients were checked for enrolment and 24 were included for analysis. Mean (SD) % variation for APTT was 432.1 (75.7) and 60.6 (23.0) for ACT with p < 0.0001. With the Bland-Altman method, value of Bias (SD) is 372 (86) with 95% limits of agreement range from 203 to 540. Pearson correlation for % variation shows r (95% CI) = -0.23 (-0.58 to 0.19) with p = 0.29 and R square = 0.05. 100% of the APTT values could be defined as excessive anticoagulation by opposition of the 8% obtained with ACT. Conclusions: This prospective observational study shows that ACT test is not well correlated with APTT and leads to a systematic excessive coagulation during EVT of IA.

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Anticoagulation monitoring during vascular surgery: accuracy of the Hemochron ® low range activated clotting time (ACT-LR)

Abstract: Hemochron Jr Signature provides measurements of ACT-LR, which are accurate for monitoring heparin anticoagulation at anti-Xa activity below 0.8 u ml(-1).

Cited by 23 publications

References 31 publications

Monitoring unfractionated heparin in pediatric patients with congenital heart disease having cardiac catheterization or cardiac surgery

Monitoring unfractionated heparin in pediatric patients with congenital heart disease having cardiac catheterization or cardiac surgery

Periprocedural management of anticoagulation for atrial fibrillation catheter ablation in direct oral anticoagulant–treated patients

Correlation Between Activated Clotting Time and Activated Partial Thromboplastin Time During Endovascular Treatment of Cerebral Aneurysms

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