Does Activated Clotting Time Help to Predict Innate Coagulopathy in End-Stage Liver Disease Patients?

Jeong, Hwoon-Yong; Kwon, Hye‐Mee; Jung, Kihyo; Moon, Young‐Jin; Jun, In Gu; Song, Jae-Kwan; Hwang, Gyu‐Sam

doi:10.1016/j.transproceed.2017.03.042

Cited by 2 publications

(2 citation statements)

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“…Importantly, an elevated ACT may not indicate residual heparin effect, as it is a whole blood clotting test. Hypothermia, low platelets, coagulation factor deficiency related to the intrinsic pathway, hemodilution, and GPIIb/IIIa antagonists can all cause elevations of the ACT 44,52 …”

Section: Management Of Post‐cardiopulmonary Bypass Coagulopathymentioning

confidence: 99%

“…Hypothermia, low platelets, coagulation factor deficiency related to the intrinsic pathway, hemodilution, and GPIIb/IIIa antagonists can all cause elevations of the ACT. 44,52 Newer strategies for heparin and protamine dosing include devices such as the Heparin Management System (HMS) Plus, which calculates a patient's heparin dose-responsiveness curve for a target ACT value, determines the heparin level at the end of bypass, and the protamine dose required to neutralize it. 53 Heparin management systems may reduce the total dose of protamine, blood loss, and transfusion, although study results have been mixed.…”

Section: Heparin Management and Protamine Reversalmentioning

confidence: 99%

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Managing the coagulopathy associated with cardiopulmonary bypass

Bartoszko

Karkouti

2021

Journal of Thrombosis and Haemostasis

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Cardiopulmonary bypass (CPB) has allowed for significant surgical advancements, but accompanying risks can be significant and must be expertly managed. One of the foremost risks is coagulopathic bleeding. Increasing levels of bleeding in cardiac surgical patients at the time of separation from CPB are associated with poor outcomes and mortality. CPB‐associated coagulopathy is typically multifactorial and rarely due to inadequate reversal of systemic heparin alone. The components of the bypass circuit induce systemic inflammation and multiple disturbances of the coagulation and fibrinolytic systems. Anticipating coagulopathy is the first step in managing it, and specific patient and procedural risk factors have been identified as predictors of excessive bleeding. Medication management pre‐procedure is critical, as patients undergoing cardiac surgery are commonly on anticoagulants or antiplatelet agents. Important adjuncts to avoid transfusion include antifibrinolytics, and perfusion practices such as red cell salvage, sequestration, and retrograde autologous priming of the bypass circuit have varying degrees of evidence supporting their use. Understanding the patient's coagulation status helps target product replacement and avoid larger volume transfusion. There is increasing recognition of the role of point‐of‐care viscoelastic and functional platelet testing. Common pitfalls in the management of post‐CPB coagulopathy include overdosing protamine for heparin reversal, imperfect laboratory measures of thrombin generation that result in normal or near‐normal laboratory results in the presence of continued bleeding, and delayed recognition of surgical bleeding. While challenging, the effective management of CPB‐associated coagulopathy can significantly improve patient outcomes.

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Section: Management Of Post‐cardiopulmonary Bypass Coagulopathymentioning

confidence: 99%