Heparin therapy during extracorporeal circulation

Bull, Brian S.; Korpman, Ralph A.; Huse, Wilfred M.; Briggs, Bernard D.

doi:10.1016/s0022-5223(19)41499-2

Cited by 277 publications

(40 citation statements)

References 5 publications

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“…Even though the ACT has been in use since the late sixties/early seventies, it still remains the gold standard to measure the effect of heparin during CPB. [3][4][5][6] This strategy, to monitor the heparin dosage for each patient based on the ACT, has proven to be superior over fixed heparin dosage schemes on postoperative blood loss. 7 ACT values greater than 400 or 480 seconds are generally maintained during CPB.…”

Section: Introductionmentioning

confidence: 99%

Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron^® Response and Hemochron^® Signature Elite

et al. 2021

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Introduction: The Activated Clotting Time (ACT) is commonly used to manage anticoagulation during cardiac surgery. The aim of this study was to compare the older manually operated Hemochron® Response and the automated Hemochron® Signature Elite. Methods: In this observational study the clinically relevant differences of both devices were investigated simultaneously, using duplicate measurements, in 29 patients who underwent a Coronary Artery Bypass Grafting (CABG) or Aortic Valve Replacement (AVR) in order to determine reliability, bias, and to detect which method has the lowest variation. Blood samples were obtained from the arterial line prior to surgery, after administration of 300 IU/kg heparin, 5 minutes after initiation of cardiopulmonary bypass and successively every 30 minutes, and after protamine administration. Results: A total of 202 measurements were performed. Of these 10 measurements were out of range in the Response and 9 in the Elite. About 27 single unstable magnet errors were seen in the Response versus no measurement errors in the Elite. No statistically significant differences between the Response (p = 0.22, Wilcoxon rank) and Elite (p = 0.064) duplicates were observed. The Response values were consistently higher during heparinization than the Elite measurements (p = 0.002, repeated measurements) with an average positive bias of around 56 seconds during heparinization (Bland-Altman). Overall, the coefficient of variation (CoV) increased during heparinization. Conclusion: The Elite was more reliable, but the variation was higher for the Elite than the Response. The observed positive bias in the Response compared to the Elite could affect heparin administration during surgery making the two systems not interchangeable.

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Section: Introductionmentioning

confidence: 99%

Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron^® Response and Hemochron^® Signature Elite

et al. 2021

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“…Heparin resistance has been defined as the use of more than 35,000 UI/day of heparin. The ACT target value is controversial; however, general recommendations establish > 400 seconds as a safe parameter (7)(8)(9)(10)(11)(12)(13). It is important to recognize factors that may alter the ACT indirectly or directly.…”

Section: Discussionmentioning

confidence: 99%

The addition of Tirofiban infusion to heparin for intraoperative heparin resistance associated with Marfan Syndrome

Fernandez-Turizo¹,

Benavidez-Zora²,

Anaya-Hoyos

et al. 2022

Colomb. J. Anesthesiol.

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Marfan syndrome classically presents with aortic root aneurysms. Aortic ectasia causes diverse blood flow alterations, influencing the behavior of coagulation factors and platelet activity. Heparin resistance has also been reported associated with Marfan Syndrome in a small number of patients, probably due to antithrombin III (ATIII) deficiency or various mutations. The ascending aorta and the aortic valve are replaced with prosthetic material during Bentall- de Bonno procedures. Resistance to anticoagulation during extracorporeal circulation, represents a significant challenge for both anesthesiologists and the surgical team. Resistance to heparin was observed in a patient with Marfan syndrome undergoing a Bentall procedure. ATIII concentrate was not available, and ACT did not increase despite high doses of heparin. An alternate anticoagulation approach was used successfully.

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“…In addition, although the noncardiogrnic pulmonary cdema after cardiopulmonary bypass can be catastrophic, its incidence is low (31, 32) Ne\w-theless, we would speculate that thc observed "injurious" effect5 of protamine on the endothelium could play a role in thc clinical setting in some situations, situations in which the blood concentration of free protamine could uninientionally increase, e.g. in the case of administration of an inadequate large amount of protamine, rapid injection of protamine, or administration of protamine to paticnts with high sensitivity to heparin (marked bariations in the sensitivity to heparin and the rate of its clearance are known (37)). Also considering the inability of heparin to reverse the injurious effects of protamine on the endothelium, we would like to recommend that the minimum possible amount of protamine should be administered slowly to prevent any unneccessary increasc in plasma concentration of free protamine during heparin rcversal.…”

Section: Discussionmentioning

confidence: 99%

Effects of heparin on the inhibitory action of protamine on endothelium‐mediated vasorelaxation

Akata

Takahashi

1995

Acta Anaesthesiol Scand

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The precise mechanism(s) of inhibitory action of protamine on endothelium-mediated vasorelaxation has not been fully elucidated. In addition, no information is available regarding the effects of a heparin-protamine complex on the endothelium-mediated relaxation. Employing isometric tension recording methods, we studied the effects of heparin, an anionic substance, on the protamine-induced inhibition of acetylcholine (ACh)-induced vasorelaxation in isolated rabbit small mesenteric artery. Protamine (> or = 50 micrograms/ml) inhibited ACh (0.03-10 microM)-induced relaxation under a norepinephrine (10 microM)-stimulated condition (P < 0.05). The ACh relaxation, even 20 min after washout of protamine (150 micrograms/ml), was still significantly inhibited as compared to the control (before protamine) ACh relaxation, and further, it was not significantly different from the ACh relaxation maximally inhibited in the presence of protamine. Preapplication of heparin (700 U/ml) almost abolished the protamine inhibition (50 & 150 micrograms/ml) of the ACh relaxation. However, heparin (700 U/ml), applied on washout of protamine (150 micrograms/ml), had no effect on the prolonged protamine inhibition. In conclusion, a heparin-protamine complex had no direct effect on the endothelium-mediated relaxation, and the inhibitory action of protamine on the endothelium-mediated relaxation might be due to its polycationic property. The prolongation of protamine inhibition and the lack of effects of heparin on the prolonged protamine inhibition may suggest a toxic effect of protamine on the endothelium.

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Heparin therapy during extracorporeal circulation

Cited by 277 publications

References 5 publications

Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron^® Response and Hemochron^® Signature Elite

Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron^® Response and Hemochron^® Signature Elite

The addition of Tirofiban infusion to heparin for intraoperative heparin resistance associated with Marfan Syndrome

Effects of heparin on the inhibitory action of protamine on endothelium‐mediated vasorelaxation

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Heparin therapy during extracorporeal circulation

Cited by 277 publications

References 5 publications

Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron® Response and Hemochron® Signature Elite

Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron® Response and Hemochron® Signature Elite

The addition of Tirofiban infusion to heparin for intraoperative heparin resistance associated with Marfan Syndrome

Effects of heparin on the inhibitory action of protamine on endothelium‐mediated vasorelaxation

Contact Info

Product

Resources

About

Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron^® Response and Hemochron^® Signature Elite

Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron^® Response and Hemochron^® Signature Elite