Whole blood heparin concentration measurements by automated protamine titration agree with plasma anti-Xa measurements

Despotis, Gj.; Joist, J. Heinrich; Goodnough, L. T.; Santoro, Samuel A.; Spitznagel, Edward L.

doi:10.1016/s0022-5223(97)70380-5

Cited by 36 publications

(16 citation statements)

References 5 publications

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“…This is also comparable with previous results by Despotis et al . 16 These limits would not be expected to cause inappropriate heparin or protamine management during cardiac surgery. Importantly, the limits of agreement between measures are very tight at low heparin concentrations, when it is critical not to incorrectly assume adequate anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Heparin monitoring during cardiac surgery. Part 1: validation of whole-blood heparin concentration and activated clotting time

et al. 2003

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There is limited published data on the agreement between techniques for monitoring heparin levels. The aim of this study was to validate the Hepcon/HMS, with particular focus on the agreement with laboratory anti-Xa assay. The performances of two ACT instruments--Hemochron and HemoTec--were also evaluated, including an assessment for interchangeability. Blood samples from 42 adult cardiopulmonary bypass (CPB) patients were analysed for activated clotting time (ACT), whole-blood heparin concentration (Hepcon/HMS) and anti-factor Xa (anti-Xa) plasma heparin concentration. Agreement between measures was determined using the method of Bland and Altman. Simple analysis of agreement between the Hepcon and anti-Xa heparin revealed the Hepcon has a mean bias of -0.46 U/mL, with the limits of agreement +/- 1.12 U/mL. The comparison between ACT instruments indicated a mean difference of -96 seconds for the HemoTec, with limits of +/- 265 seconds. The Hepcon/ HMS instrument displayed satisfactory agreement with anti-Xa plasma heparin concentration, as the expected variation would not be expected to cause problems in the clinical setting. Agreement between the two measurements of ACT may be satisfactory, provided each is assigned a different target value.

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Section: Discussionmentioning

confidence: 99%

Heparin monitoring during cardiac surgery. Part 1: validation of whole-blood heparin concentration and activated clotting time

et al. 2003

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“…2 The Hepcon HMS establishes whole blood heparin concentration using an automated heparin-protamine titration method. However, there are concerns that during CPB, the HMS assay may over-estimate the heparin dose that is required compared to a manual-based ACT method (Despotis et al, 1997).…”

Section: Modifications Of the Thrombin Timementioning

confidence: 99%

“…This establishes whole blood heparin concentration using an automated heparin-protamine titration method but may over-estimate the heparin dose that is required during CPB compared to a manual-based ACT (Despotis et al, 1997). In summary, POCT with protamine titration (HMS) or high dose thrombin time (HiTT) will provide conformation of heparin neutralization but, despite the limitations of ACT in detecting low concentrations of heparin, residual heparin following protamine neutralization is uncommon in the period after uncomplicated CPB (Murray et al, 1997).…”

Section: Lesserson 2005)mentioning

confidence: 99%

Point‐of‐care testing in haemostasis

Perry

Fitzmaurice

Kitchen³

et al. 2010

Br J Haematol

124

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SummaryPoint-of-care testing (POCT) in haematology has seen a significant increase in both the spectrum of tests available and the number of tests performed annually. POCT is frequently undertaken with the belief that this will reduce the turnaround time for results and so improve patient care. The most obvious example of POCT in haemostasis is the out-ofhospital monitoring of the International Normalized Ratio in patients receiving a vitamin K antagonist, such as warfarin. Other areas include the use of the Activated Clotting Time to monitor anticoagulation for patients on cardio-pulmonary bypass, platelet function testing to identify patients with apparent aspirin or clopidogrel resistance and thrombelastography to guide blood product replacement during cardiac and hepatic surgery. In contrast to laboratory testing, POCT is frequently undertaken by untrained or semi-trained individuals and in many cases is not subject to the same strict quality control programmes that exist in the central laboratory. Although external quality assessment programmes do exist for some POCT assays these are still relatively few. The use of POCT in haematology, particularly in the field of haemostasis, is likely to expand and it is important that systems are in place to ensure that the generated results are accurate and precise.Keywords: point-of-care testing, haemostasis, quality assurance, near patient testing.Point-of-care testing (POCT) is defined as a diagnostic test at or near the site of the patient with the rationale that such testing will result in the rapid generation of results and improve patient care. POCT is frequently undertaken by nonlaboratory personnel both within and outwith the hospital setting and the last 10 years has seen a significant increase in its use, particularly in the field of haemostasis. The importance of POCT is highlighted by a recent publication from the This review summarizes POCT in relation to haemostasis, and complements a previously published guideline by the British Committee for Standards in Haematology on POCT in Haematology (Briggs et al, 2008).

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“…The correlation between the protamine titration method and the enzymatic determination of heparin levels remains controversial. [34][35][36] While they may correlate, the results are not interchangeable.…”

Section: Monitoring Of Heparin Concentration During Cpbmentioning

confidence: 99%

Antithrombotic therapy in cardiac surgery

Vincentelli

Jude

Bélisle

2006

Can J Anesth/J Can Anesth

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Purpose: To review the perioperative management of antithrombotic therapy in cardiac surgery, including the management of cardiopulmonary bypass (CPB) and off-pump surgery.Methods: A review of the relevant English literature over the period was undertaken, in addition to a review of international practices in antithrombotic therapy in cardiac surgery. Principal findings:Cardiopulmonary bypass is required in most procedures and makes anticoagulation mandatory. Anticoagulation is, usually, achieved with unfractionnated heparin (UFH). Unfractionated heparin is monitored by point-ofcare (POC) testing, such as the activated clotting time or the determination of heparin concentration. The target values of both tests remain empirical, with no clearly validated thresholds. The target value needs to be adjusted according to the POC test, given significant variations between devices and activators. After CABG, the need for antiplatelet therapy is well demonstrated, in order to limit the risk of postoperative death or ischemic events, and improve venous graft patency. Immediately after valvular surgery, antithrombotic therapy should take into account the specific risk carried by each patient and by each prosthetic device. The risk of venous thromboembolism, though poorly defined, is also present in the postoperative period and may require additional attention. Given the frequent exposure to UFH, occurrence of heparininduced thrombocytopenia is not infrequent in these patients and requires careful individual management. Conclusions:Antithrombotic therapy is an essential component of cardiac surgery. Yet, with the exception of antiplatelet agents in CABG patients, antithrombotic therapy is often based on the clinical experience of medical teams more than on an evidence-based assessment of the literature. Objectif Constatations principales : La circulation extracorporelle est nécessaire pour la majorité des opérations et rend l'anticoagulation obligatoire. L'anticoagulation est, habituellement, réalisée avec de l'héparine non fractionnée (HNF). L'HNF est contrôlée par des tests faits au chevet du malade comme le temps de coagulation activée ou la détermination de la concentration d'héparine. Les valeurs cible des deux tests demeurent empiriques, sans valeurs seuil clairement validées. La valeur cible doit être ajustée en fonction de chaque test de chevet à cause des variations significatives entre les instruments et les activateurs. Après le pontage aortocoronarien (PAC), la nécessité d'un traitement antiplaquettaire a été bien démontrée, qui vise à limiter les décès postopératoires ou les incidents ischémiques et à améliorer la

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Whole blood heparin concentration measurements by automated protamine titration agree with plasma anti-Xa measurements

Cited by 36 publications

References 5 publications

Heparin monitoring during cardiac surgery. Part 1: validation of whole-blood heparin concentration and activated clotting time

Heparin monitoring during cardiac surgery. Part 1: validation of whole-blood heparin concentration and activated clotting time

Point‐of‐care testing in haemostasis

Antithrombotic therapy in cardiac surgery

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