Monitoring of anticoagulation in aprotinin-treated patients during heart operation

Tabuchi, Noriyuki; Njo, Tjin L.; Tigchelaar, Izaak; Huyzen, Rob J.; Boonstra, Piet W.; Oeveren, Willem van

doi:10.1016/0003-4975(94)90747-1

Cited by 19 publications

(4 citation statements)

References 17 publications

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“…HiTT decreases on CPB, as does the heparin concentration, in contrast to the ACT, which increases. HiTT is unaffected by aprotinin therapy; 21 however, it may be less accurate than the Hepcon protamine titration assay in predicting heparin concentrations of less than 4.8 U/mL in patients receiving aprotinin. 22 As a monitor, HiTT is also less affected than ACT by the heparin resistance seen in patients on preoperative heparin infusions.…”

Section: High-dose Thrombin Timementioning

confidence: 93%

Evidence Based Coagulation Monitors: Heparin Monitoring, Thromboelastography, and Platelet Function

Shore‐Lesserson¹

2005

Semin Cardiothorac Vasc Anesth

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The hemostatic management of patients undergoing cardiac surgery is a unique challenge. Since its inception, cardiopulmonary bypass (CPB) has required meticulous attention to maintaining adequate anticoagulation. New anticoagulants and alternative monitoring techniques present an opportunity to investigate potential advances in the area of anticoagulation for CPB. Hemostasis after CPB is still a vexing problem, and the addition of antiplatelet medication to the platelet defect already incurred during CPB has led to hemorrhagic complications in cardiac surgery. The two opposing processes of anticoagulation and hemostasis must be managed carefully and modified with respect to the patient's hematologic status and desired hemostatic outcome. Cardiac surgical patients consume a much larger fraction of perioperative blood transfusions than the percentage of the surgical population they represent. Thus, during CPB, careful attention must be paid to optimal anticoagulation, platelet quiescence, biocompatible circuitry and interventions, and to monitoring hemostasis. The multifactorial etiology of the CPB-induced hemostatic defect requires a multimodal approach to blood conservation and hemostasis monitoring, including heparin maintenance and sophisticated point-of-care hemostasis monitoring. Each technology has its own attributes and each may be suitable for different populations based upon the expected defects being measured. This article reviews the evidence supporting the use of point-of-care monitors in coagulation and hemostasis management in cardiac surgical patients.

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Section: High-dose Thrombin Timementioning

confidence: 93%

Evidence Based Coagulation Monitors: Heparin Monitoring, Thromboelastography, and Platelet Function

Shore‐Lesserson¹

2005

Semin Cardiothorac Vasc Anesth

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“…A stepwise HiPT response to incremental heparin concentrations was recently demonstrated by Tabuchi et al, 108 but more evaluations are needed to adequately evaluate this assay's relation to heparin concentration values (anti-Xa chromogenic assay), markers of hemostatic activation (e.g., FPA or fibrin monomer levels), and clinical usefulness. This whole blood measurement is activated by rabbit brain thromboplastin.…”

Section: Newly Developed Monitoring Techniquesmentioning

confidence: 96%

Anticoagulation Monitoring during Cardiac Surgery

et al. 1999

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The literature does not consistently support the importance of anticoagulation monitoring techniques during CPB. This is best reflected by studies that have evaluated the impact of the ACT method on blood loss and transfusion outcomes. Inconsistent findings from studies that evaluated the impact of ACT monitoring may be related to either suboptimal study design (i.e., retrospective, unblinded, nonrandomized) or possibly the diagnostic inprecision of the ACT method used in these studies. There are a small number of well-controlled studies, some of which suggest that bleeding and transfusion outcomes can be improved by refining heparin monitoring techniques, either by sustaining better anticoagulation during CPB or by optimizing protamine doses (i.e., when empiric protocols result in excessive protamine doses). More well-controlled studies are needed to better define the importance of anticoagulation management during CPB.

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“…The High dose Thrombin Time (HiTT) is a modified Thrombin Time test (TT) which reflects functional heparin levels and actual anti-coagulation status (1,2,8,9). The HiTT is similar to the common TT as it is neither affected by antifibrinolytic drugs nor by hypothermia, hemodilution, minor decreases in fibrinogen and accumulation of fibrin degradation products (1,7).…”

Section: Introductionmentioning

confidence: 99%

“…At that time comparative ACT/HiTT assays were performed and consequently the HiTT value of 190 seconds corresponding with the target ACT of 480 seconds was established (10). In several studies the HiTT was compared with the ACT in the presence of aprotinin, the overall conclusion was that the HiTT is a more useful assay for monitoring heparin during CPB than the ACT (2,(8)(9)(10). In this clinical study we compared the HiTT with the ACT during CPB in non-aprotinin treated patients.…”

Section: Introductionmentioning

confidence: 99%

High Dose Thrombin Time versus the Activated Clotting Time during Cardiopulmonary Bypass

de Jong

1999

J Extra Corpor Technol

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In this study we compared the High Dose Thrombin Time (HiTT) with the Activated Clotting Time (ACT) during cardiopulmonary bypass (CPB) in non-aprotinin treated patients. On the advice of the HiTT test manufacturer each institution should perform comparative ACT/HiTT assays in the cardiac surgery population. In previous tests our target ACT value of 480 seconds corresponds with a mean HiTT value of 190 seconds. Our results showed that after heparinization (300–400 IU/kg body weight) 8 out of 20 patients did not reach the target ACT of 480 seconds, while the HiTT results in those 8 patients were higher than our target time of 190 seconds. Four heparin pretreated patients who received 400 IU/kg heparin, had relatively low ACT values (467 ± 14 sec.) and high HiTT values (324 ± 47 sec.). Before and during CPB there was a poor correlation between the HiTT and ACT (r = 0.38). The results of this study show that for the individual patient the target HiTT of 190 seconds is no guarantee for reaching an adequate ACT of 480 seconds. Although the HiTT may be a very useful assay for monitoring heparin effects during CPB, the determination of the target time can be a point of discussion. In contrast of the advice of the manufacturer we therefore suggest that comparative ACT/HiTT assay should be done in every individual patient to determine a safe target HiTT time, instead of the whole group of patients.

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Monitoring of anticoagulation in aprotinin-treated patients during heart operation

Cited by 19 publications

References 17 publications

Evidence Based Coagulation Monitors: Heparin Monitoring, Thromboelastography, and Platelet Function

Evidence Based Coagulation Monitors: Heparin Monitoring, Thromboelastography, and Platelet Function

Anticoagulation Monitoring during Cardiac Surgery

High Dose Thrombin Time versus the Activated Clotting Time during Cardiopulmonary Bypass

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