Monitoring of intraoperative heparinization and blood loss following cardiopulmonary bypass surgery

Babka, Ronald; Colby, Clarence; El-Etr, Adel A.; Pifarré, Roque

doi:10.1016/s0022-5223(19)41482-7

Cited by 67 publications

(18 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are studies that shows monitorization and management of anticoagulation with ACT during CPB cause minimum post-operative bleeding and blood transfusion. (15)(16)(17) During CPB some studies point that heparin dose and anticoagulation is not proportional but there is an exponential relation between them. (18,19) There is not a universal figure for an optimal ACT time for CBP, but 400-480 seconds of ACT stands as consensus.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass about Postoperative Drainage and Blood Transfusion

Özkan¹,

Özkan²,

Oto³

2018

ejcm

View full text Add to dashboard Cite

Coagulation cascade starts with exsanguination or any contact of blood with an extracorporeal surface (1-5). Since invention of heparin molecule in 1916, it has been an essential application for cardiopulmonary bypass (CPB). Nowadays during CPB we have been using Activated Clotting Time (ACT) test because it results quicker than other laboratory tests to evaluate anticoagulation of heparin. (6-10) During CPB, high anticoagulation levels would result with unexpected high rate non-surgical bleeding. However, lower anticoagulation doses would end up with high rate of thromboembolic events. Both situations can be related with high mortality or morbidity. (13) There have been guidelines about blood conservation in cardiac surgery but clinical management of anticoagulation during CPB is not standardized. (14) In this respect, so far there has not been an ideal universal ACT value. Most clinics sets ACT target as above 400-480 seconds during CPB. (11,12) Over the years most clinics apply 300 IU/kg dose heparin regimen which has been empirically advanced and universally accepted for CPB to reach target ACT values, but this regimen sometimes can lead to higher ACT values. (13) This situation may cause to more postoperative bleeding, more postoperative blood transfusion and prolonged intensive care staying, although heparin is antagonized with protamine at the end of CPB. In this study we would like to compare retrospectively patients under went open heart surgery whom ACT's during CPB were 400-650 seconds with the patients whom ACT's were 650 seconds and higher during CPB.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass about Postoperative Drainage and Blood Transfusion

Özkan¹,

Özkan²,

Oto³

2018

ejcm

View full text Add to dashboard Cite

show abstract

“…3,4 Although doses vary from institution to institution, various studies have demonstrated adequate reversal of heparin when 1 to 2 mg of protamine are administered for every milligram of heparin. 7,11 However, the reappearance of heparin activity in the postoperative period has been blamed as the cause of postoperative bleeding. 9 We demonstrated that from 1 to 5 hours after operation, the plasma clotting times were abnormally elevated and were brought back to normal only after the addition of protamine.…”

Section: Discussionmentioning

confidence: 99%

“…The activated clotting time (ACT), measured with a Hemochron (International Technidyne Corp., Edison, NJ), provides an objective determination of the heparinization level before and during cardiopulmonary bypass. 10,11 At the conclusion of cardiopulmonary bypass, it determines the patient's level of and the total dose of protamine necessary for the reversal of the heparin effect.…”

mentioning

confidence: 99%

Management of Blood Loss and Heparin Rebound Following Cardiopulmonary Bypass

Pifarré¹,

Sullivan²,

Montoya³

et al. 1989

Semin Thromb Hemost

View full text Add to dashboard Cite

The number of open heart operations continues to increase all over the world. Concern for the number of blood units used and the strain placed on blood bank resources has been voiced by many investigators. Many efforts are being made to reduce the use of bank blood by the use of autologous blood retrieval and transfusion.It is a well-recognized fact that the longer the pump time, the greater the blood loss and the blood requirement during and after a procedure. Because the experience of the surgical team influences the length of the procedure, blood requirements are reduced as experience increases. However, there are other factors that influence blood coagulation, blood loss, and blood replacement during an open heart operation.The status of the coagulation mechanism before operation must be evaluated carefully. Some patients are referred for operation while receiving intravenous heparin, administered to help manage accelerating angina or to prevent emboli in patients with atrial fibrillation. Others have been taking oral anticoagulants until a few days before the operation, and still others take an aspirin daily as a prophylactic agent to prevent heart attacks. In a patient in either of the last two categories, although the coagulation profile may be back to normal, it can be assumed that intraoperative and postoperative bleeding will be increased, and proper measures must be taken.The extensive and successful use of cardiopulmonary bypass has been enhanced through the use of heparin and the accurate and complete reversal of the heparin effect with protamine sulfate. 1 " 4 After cardiopulmonary bypass, satisfactory hemostasis will not be accomplished if the reversal of heparin effect is only temporary. The rate at which heparin is metabolized, the amount of protamine necessary for its reversal, and the patient's response to heparin are subject to wide individual variations. [5][6][7][8] The reappearance of hypocoagulability after adequate neutralization of heparin has been called "heparin rebound." After investigating this phenomenon, Gollub 9 concluded that the hypocoagulability was due to the reappearance of heparin in the circulating blood.The activated clotting time (ACT), measured with a Hemochron (International Technidyne Corp., Edison, NJ), provides an objective determination of the heparinization level before and during cardiopulmonary bypass. 10, 11 At the conclusion of cardiopulmonary bypass, it determines the patient's level of and the total dose of protamine necessary for the reversal of the heparin effect.To investigate further the phenomenon of heparin rebound, we have combined the use of the Hemochron with the Hepcon automatic heparin analyzer (Hepcon System A-10, Hemotec, Inc., Englewood, CO).

show abstract

“…[76][77][78][79] Protocols for anticoagulation for cardiopulmonary bypass vary. [83][84][85] The ACT is routinely used to determine the adequacy of anticoagulation both before and during CPB. 83,86,87 Although there is controversy as to what the optimal ACT for CPB is, 75,88 400 to 480 seconds has been accepted.…”

Section: Anticoagulation For Cpbmentioning

confidence: 99%

“…[83][84][85] The ACT is routinely used to determine the adequacy of anticoagulation both before and during CPB. 83,86,87 Although there is controversy as to what the optimal ACT for CPB is, 75,88 400 to 480 seconds has been accepted. The lack of gross clot formation during CPB does not necessarily ensure thrombin inhibition, with subsequent activation of the coagulation cascade and platelets, depletion of clotting factors, and the initiation of fibrinolysis.…”

Section: Anticoagulation For Cpbmentioning

confidence: 99%

Recombinant Antithrombin: Production and Role in Cardiovascular Disorder

Levy¹,

Weisinger²,

Ziomek³

et al. 2001

Semin Thromb Hemost

View full text Add to dashboard Cite

Plasma-derived antithrombin (AT) concentrates have been used for the management of hereditary and acquired deficiencies since the early 1980s. Recombinant versions of other blood factors and their derivatives are increasingly becoming available, providing a safe and abundant supply of these important therapeutics. However, the complexity of the AT molecule and the large doses often required for supplementation treatments preclude the use of traditional cell culture bioreactors for recombinant production. The development of a very efficient expression system has been necessary for the cost-efficient recombinant production of AT. Transgenic production, with its ability to yield high levels of heterologous protein and its scale-up flexibility, is an attractive alternative to plasma fractionation. Purification of recombinant AT from the milk of transgenic dairy goats has been developed to provide a homogeneous, well-defined, and abundant supply of this factor. This article describes the production of recombinant AT and aspects of clinical applications of this molecule to cardiovascular disorders.

show abstract

Monitoring of intraoperative heparinization and blood loss following cardiopulmonary bypass surgery

Cited by 67 publications

References 9 publications

Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass about Postoperative Drainage and Blood Transfusion

Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass about Postoperative Drainage and Blood Transfusion

Management of Blood Loss and Heparin Rebound Following Cardiopulmonary Bypass

Recombinant Antithrombin: Production and Role in Cardiovascular Disorder

Contact Info

Product

Resources

About