The activated coagulation time: Suitability for monitoring heparin effect and neutralization during pediatric cardiac surgery

Martindale, Sarah J.; Shayevitz, Jay R.; DʼErrico, Celia

doi:10.1016/s1053-0770(05)80004-7

Cited by 47 publications

(20 citation statements)

References 22 publications

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“…The ACT is currently a standard procedure for monitoring anticoagulation in extracorporeal circuits, such as in clinical settings of cardiopulmonary bypass, hemodialysis, and apheresis treatment, and during surgical and interventional procedures requiring anticoagulative treatment, including cardiac and vascular surgery [15][16][17]. The ACT has also been advocated as a routine preoperative screening test for detecting coagulation disorders [18,19].…”

Section: Discussionmentioning

confidence: 99%

Management of regional citrate anticoagulation in pediatric high-flux dialysis: activated coagulation time versus post-filter ionized calcium

et al. 2010

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Recent years has seen an increasing use of regional citrate anticoagulation in pediatric dialysis. Several approaches have been described for monitoring anticoagulation in the extracorporeal circuit, such as serum citrate levels, post-filter ionized calcium (iCa), and activated coagulation time (ACT). However, no standard recommendations have yet been established for applying any of these parameters, especially for iCa. The objective of this retrospective analysis was to establish adequate coagulation management using post-filter iCa values. Normal values for ACTester-based ACT were established using a group of 64 children who were divided into two subgroups, with one subgroup comprising children without chronic kidney disease or coagulation disorder (age 1.2-17.5 years, median 9.7 years) and one consisting of 32 uremic patients (age 0.6-17.5 years, median 13.7 years). In a second group of 13 patients (aged 7-17 years), all of whom were undergoing high-flux dialysis (HD) with regional citrate anticoagulation (RCA), we assessed 73 post-filter blood samples for ionized calcium and ACT. A receiver operating characteristic graph was used to identify the iCa threshold needed to achieve adequate anticoagulation. Normal values for ACT were 90 s [2 standard deviations (SD) 72-109] in healthy children and 94 s (2 SD 75-113) in the uremic children. There was no statistically significant difference between the groups. In the children undergoing HD with RCA, the post-filter iCa level correlated with ACT (r = -0.94, p < 0.001). A post-filter iCa level of < or = 0.30 mmol/l reliably predicted an ACT >120 s. Our citrate protocol [citrate 3% rate (ml/h) approximately blood flow rate (ml/min) x 2] meets the established criteria with a high sensitivity. Based on these results, we conclude that the post-filter iCa level can be reliably used for the management of extracorporeal anticoagulation with citrate in pediatric HD. We recommend the application of our citrate prescription protocol in the setting of pediatric intermittent hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Management of regional citrate anticoagulation in pediatric high-flux dialysis: activated coagulation time versus post-filter ionized calcium

et al. 2010

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“…A number of different 4 laboratory assays have been used to enable adjustment of heparin doses. Most commonly used are clot-based assays in the form of the activated partial thromboplastin time (APTT) [10] and the activated clotting time (ACT) [11]. Nevertheless, it is well established that these assays have a number of important limitations.…”

Section: Introductionmentioning

confidence: 99%

Development of a fluorescent anti-factor Xa assay to monitor unfractionated and low molecular weight heparins

Harris

Castro-López

Hammadi

et al. 2010

Talanta

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Fluorogenic assays have many potential advantages over traditional clot-based and chromogenic assays such as the absence of interference from a range of factor deficiencies as well as offering the possibility of assays in platelet rich plasma or whole blood. A fluorogenic anti-factor Xa (anti-FXa) assay has been developed for the determination of heparin-like anticoagulants including unfractionated heparin (UFH), low-molecular weight heparins (LMWHs), namely enoxaparin and tinzaparin, and the synthetic heparinoid danaparoid, in commercial human pooled plasma. The assay was based on the complexation of heparinspiked plasmas with exogenous FXa at a concentration of 4 nM in the presence of 0.9 µM of the fluorogenic substrate methylsulfonyl-D-cyclohexylalanyl-glycyl-arginine-7-amino-4-methylcoumarin acetate (Pefafluor FXa). Pooled plasma samples were spiked with concentrations of anticoagulants in the range 0 to 1.6 U/ml. The assay was capable of the measurement of UFH and danaparoid in the range 0-1 U/ml, and enoxaparin and tinzaparin in the range 0-0.8 U/ml and 0-0.6 U/ml, respectively. Assay percentage coefficients of variation were typically below 7 %.3

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“…However, correlation between ACT and blood heparin levels in children is low, probably due to pediatric perfusion characteristics, such as higher hemodilution, homologous blood utilization, fibrinolysis, thrombocytopenia, platelet activation, hypothermia and coagulation factors deficiency. But this poor correlation with heparin blood levels does not lower the importance of ACT because, in practical terms, knowing blood coagulation status is more important than knowing heparin blood level 27 . Protamin dose needed to neutralize heparin is proportionally higher in NN as compared to older children and adults 28 .…”

Section: Anticoagulation and Its Reversionmentioning

confidence: 99%

“…No entanto, a correlação entre os valores do TCA e os níveis de heparina no sangue é baixa nas crianças, possivelmente por conta de fatores característicos da perfusão pediátrica como a maior hemodiluição, o uso de sangue homólogo, fibrinóli-se, trombocitopenia, ativação plaquetária, hipotermia, e a deficiência de fatores da coagulação. Mas esta baixa correlação com os níveis sangüíneos de heparina não tira a importância do TCA porque, do ponto de vista prático, mais importante que o nível sangüíneo de heparina é saber o estado da coagulação do sangue 27 . Adose de protamina necessária para neutralizar a heparina é proporcionalmente maior no recém-nascido que nas crianças maiores e adultos 28 .…”

Section: Tenório Cumino E Gomes Figura 1 -Truncus Arteriosusunclassified

Anestesia para o recém-nascido submetido a cirurgia cardíaca com circulação extracorpórea

Tenório¹,

Cumino²,

Gomes³

2005

Rev. Bras. Anestesiol.

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The activated coagulation time: Suitability for monitoring heparin effect and neutralization during pediatric cardiac surgery

Cited by 47 publications

References 22 publications

Management of regional citrate anticoagulation in pediatric high-flux dialysis: activated coagulation time versus post-filter ionized calcium

Management of regional citrate anticoagulation in pediatric high-flux dialysis: activated coagulation time versus post-filter ionized calcium

Development of a fluorescent anti-factor Xa assay to monitor unfractionated and low molecular weight heparins

Anestesia para o recém-nascido submetido a cirurgia cardíaca com circulação extracorpórea

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