Hemostasis Management by Use of Hepcon/HMS™: Increased Bleeding Without Increased Need for Blood Transfusion

Beholz, Sven; Grubitzsch, Herko; Bergmann, Britta; Hg, Wollert; Eckel, Lothar

doi:10.1055/s-2007-1013166

Cited by 17 publications

(8 citation statements)

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“…26,79,98e112 The risk of bias according to the Cochrane Risk of Bias tool is shown in Supplementary Table 2. 113 The majority of these studies reported haemostatic test results, such as heparin or protamine dose, 79,98,100,106,109 thrombin anti-thrombin concentrations or thrombin potential, 99,100,105 haemostatic activation, 101,102 or platelet function 26,102 as study endpoints. Only a few studies were primarily designed to study the association of protamine titration with postoperative blood loss and transfusion requirements, 104,107,110e112 but frequently without providing a sample-size calculation.…”

Section: Resultsmentioning

confidence: 99%

“…The first study found increased 6 h blood loss in the protamine-titration group. 109 Albeit not the primary endpoint, the second study also reported higher 12 h blood loss volumes in the protamine-titration group {median 420 [inter-quartile range (IQR) 337.5e605.0] ml} compared with the control group [median 345 (IQR 230.0e482.5) ml; P¼0.0041]. 100 It is, however, unknown whether the mixed inclusion of on-pump, OPCAB, and miniaturised extracorporeal therapy cases, and the absent publication of concomitant ACT values may have influenced these results.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Boer

Meesters

Veerhoek

et al. 2018

British Journal of Anaesthesia

162

146

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Neutralisation of systemic anticoagulation with heparin in cardiac surgery with cardiopulmonary bypass requires protamine administration. If adequately dosed, protamine neutralises heparin and reduces the risk of postoperative bleeding. However, as its anticoagulant properties are particularly exerted in the absence of heparin, overdosing of protamine may contribute to bleeding and increased transfusion requirements. This narrative review describes the mechanisms underlying the anticoagulant properties and side-effects of protamine, and the impact of protamine dosing on the activated clotting time and point-of-care viscoelastic test results, and explains the distinct protamine dosing strategies in relation to haemostatic activation and postoperative bleeding. The available evidence suggests that protamine dosing should not exceed a protamine-to-heparin ratio of 1:1. In particular, protamine-to-heparin dosing ratios >1 are associated with more postoperative 12 h blood loss. The optimal protamine-to-heparin ratio in cardiac surgery has, however, not yet been elaborated, and may vary between 0.6 and 1.0 based on the initial heparin dose.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Boer

Meesters

Veerhoek

et al. 2018

British Journal of Anaesthesia

162

146

View full text Add to dashboard Cite

show abstract

“…Vollblutmethoden werden breit zur Steuerung der intravenösen Antikoagulanzien bei der extrakorporalen Zirkulation, bei Interventionen und in der Intensivmedizin eingesetzt. (2,4). Eine Erfolgsgeschichte ist in diesem Zusammenhang das Patientenselbstmanagement bei Antikoagulation mit Vitamin-K-Antagonisten.…”

Section: Qualitätssicherung Bei Poct-methoden In Der Hämostaseologie unclassified

POCT in coagulation

Dick¹,

Junker²,

Spannagl³

2010

Hamostaseologie

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In the last years several point of care testing (POCT) systems used for coagulation parameters have been developed and became daily routine. As for other POCT applications (e. g. blood gas analysis) there is a need for user education and continuous improvement of quality assurance. For some POCT coagulation systems a comprehensive quality management has not been established yet. According to the feasibility and availability of control material and system self control each POCT coagulation method described in this article has a varying concept of quality management. Besides a high quality standard in manufacturing systems, devices and reagents the education of the user and the automatic self control of the instrument as well as the application of electronic and/ or liquid control samples contribute to the total quality assurance. Even if a "like versus like" control material is not available a comprehensive quality management should be implemented in daily routine concerning pre-analytic as well as technical and post-analytic criteria. Anyway to do nothing as the available control material seems to be not suitable is a bad decision.

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“…In der Literatur ist eine bessere Korrelation zum Heparinspiegel als bei der ACT beschrieben [4,9]. Sie wird zur Heparinbestimmung eingesetzt.…”

Section: Heparin Management System (Hms)unclassified

Point-of-Care Analyse des Hämostasesystems/Point-of-Care Analysis of the Hemostatic System

Spannagl¹,

Calatzis²

2002

LaboratoriumsMedizin

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Hemostasis Management by Use of Hepcon/HMS™: Increased Bleeding Without Increased Need for Blood Transfusion

Abstract: Use of the Hepcon/HMS-system for monitoring of heparinization during extracorporeal circulation is possible without increased risk of thromboembolism. Postoperative blood loss was slightly but significantly increased but there was no need for more heterogenous transfusion.

Cited by 17 publications

References 0 publications

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

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

POCT in coagulation

Point-of-Care Analyse des Hämostasesystems/Point-of-Care Analysis of the Hemostatic System

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