The use of the activated clotting time for monitoring heparin therapy in critically ill patients

Waele, Jan J. De; Cauwenberghe, S Van; Hoste, Eric A. J.; Benoît, Dominique; Colardyn, Francis

doi:10.1007/s00134-002-1609-7

Cited by 54 publications

(32 citation statements)

References 13 publications

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“…One of the limitations of this study is that our anticoagulant protocol is based on activated clotting time. According to a previous report (De Waele et al. , 2003), activated clotting time is less sensitive than APTT in low dose UFH (5000–10 000 U/day).…”

Section: Discussionmentioning

confidence: 91%

Antithrombin effect on coagulation and fibrinolytic profiles after living donor liver transplantation: a pilot study

Kaneko¹,

Sugawara²,

Tamura³

et al. 2009

Int J Lab Hematology

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Early after liver transplantation, patients are in a hypercoagulable state because of an imbalance between coagulation and fibrinolysis because of the slow recovery of depleted anticoagulant proteins. Antithrombin (AT) is used in anticoagulant protocols to prevent thrombosis. The subjects of the present study were 17 men and eight women that underwent living donor liver transplantation. The initial 15 cases were administered AT concentrate (1500 U/day) on postoperative days (POD) 1 through 3 (AT group) and the following 10 consecutive cases were not administered AT (control). AT, thrombin-AT complex, plasmin-alpha2 plasmin inhibitor complex, thrombomodulin, fibrin degradation product D-dimer (FDP-DD) level, prothrombin time international normalized ratio, activated partial thromboplastin time, and platelet counts were measured. In the AT group, AT activity was maintained at levels >80% for 5 days after transplantation. In the control group, AT activity did not return to normal during the first 2 weeks after the operation. FDP-DD levels were significantly higher in the control group than in the AT group (P < 0.05). Six patients in the control group and three patients in the AT group required transfusions with platelet concentrate (P < 0.05). AT supplementation might reduce FDP-DD levels and prevent decreased platelet counts in the early stages after liver transplantation.

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Section: Discussionmentioning

confidence: 91%

Antithrombin effect on coagulation and fibrinolytic profiles after living donor liver transplantation: a pilot study

Kaneko¹,

Sugawara²,

Tamura³

et al. 2009

Int J Lab Hematology

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“…On the other hand, the use of a catheter is preferred over venipuncture because it reduces irritation, anxiety and superficial bleeding risk. The patient feels more comfortable as well (Sharma et al 1982, Molyneaux et al 1987, GUSTO Investigators 1993, De Waele et al 2003.…”

Section: Introduction and Objectivementioning

confidence: 99%

Comparison of two blood sampling methods in anticoagulation therapy: venipuncture and peripheral venous catheter

Zengin¹,

Enç²

2008

Journal of Clinical Nursing

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“…The ACT has also been shown to be imprecise in monitoring low levels of heparin anticoagulation . During CVVH, initial anticoagulation control appears to be easier to manage with crystalloids than with colloids.…”

Section: Discussionmentioning

confidence: 99%

Impact of Different Types of Resuscitation Fluids on Coagulation and Continuous Venovenous Hemofiltration Hemocompatibility in a Porcine Model

et al. 2013

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Abstract:Intensive therapy demanding diseases (organ failure or sepsis) are assumed to be the etiology behind a decreased biocompatibility of extracorporeal systems for renal replacement therapy (RRT). There are also potential interactions between different components of the overall therapy. Volume substitutes are known to influence hemorheology and coagulation. To define a potential net effect of volume substitutes on the hemocompatibility of an RRT, we chose an animal model without interfering pathophysiologies. According to the problem of early filter failure and coagulation disorders in critically ill patients, we focused on the hypothesized interaction between RRT and different volume substitutes with respect to blood cell counts, coagulation parameters and required heparin dose. Forty-eight pigs were assigned to four groups of fluid therapy with either normal saline (NaCl), 6%HES130kD/ 0.4 (HES130), 6%HES200kD/0.5 (HES200) or 4%gelatin (GEL). Six pigs of each fluid group underwent continuous venovenous hemofiltration (CVVH), the remaining six served as the control group. Anticoagulation was performed with continuous heparin infusion. CVVH was run in a recirculation-mode for 4.5 h to force hemocompatibility reactions, thereafter in a standard-mode for 2 h. During the CVVH-treatment GEL reduced platelet counts and fibrinogen concentration and additionally lowered ATIII levels. Heparin requirements did not differ between different volume substitutes or CVVH and control groups. Severe pathophysiologies are not the only reason for a reduced hemocompatibility of CVVH treatment. Interaction of a particular volume substitute with CVVH should be considered when interpreting study results and evolving new strategies.

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The use of the activated clotting time for monitoring heparin therapy in critically ill patients

Abstract: The correlation between the aPTT and the ACT in this ICU setting is poor; ACT cannot differentiate between low and therapeutic levels of anticoagulation. The use of the ACT for monitoring low to moderate doses of heparin in ICU patients cannot be recommended.

Cited by 54 publications

References 13 publications

Antithrombin effect on coagulation and fibrinolytic profiles after living donor liver transplantation: a pilot study

Antithrombin effect on coagulation and fibrinolytic profiles after living donor liver transplantation: a pilot study

Comparison of two blood sampling methods in anticoagulation therapy: venipuncture and peripheral venous catheter

Impact of Different Types of Resuscitation Fluids on Coagulation and Continuous Venovenous Hemofiltration Hemocompatibility in a Porcine Model

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