Anticoagulant Effect of Standard Dose Heparin During Peripheral Endovascular Intervention

Nissborg, Emelie; Wahlgren, Carl‐Magnus

doi:10.1016/j.avsg.2019.02.033

Cited by 9 publications

(5 citation statements)

References 26 publications

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“…Although the optimal target ACT has not been set in guidelines, research suggests an ACT between 200 and 250 s may be preferable during NCAP, to minimize the TEC risk without compromising procedural success or increasing bleeding complications [ 37 , 38 ]. Previous studies on heparinization during NCAP found a lower incidence of TEC in patients receiving an ACT-guided heparinization protocol (9%) compared to a single heparin bolus of 5 000 IU (4.3%) [ 4 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Activated clotting time-guided heparinization during open AAA surgery: a pilot study

Roosendaal,

Hoebink,

Wiersema

et al. 2024

Pilot Feasibility Stud

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Background Arterial thrombo-embolic complications (TEC) are still common during and after non-cardiac arterial procedures (NCAP). While unfractionated heparin has been used during NCAP for more than 70 years to prevent TEC, there is no consensus regarding the optimal dosing strategy. The aim of this pilot study was to test the effectiveness and feasibility of an activated clotting time (ACT)-guided heparinization protocol during open abdominal aortic aneurysm (AAA) surgery, in anticipation of a randomized controlled trial (RCT) investigating if ACT-guided heparinization leads to better clinical outcomes compared to a single bolus of 5000 IU of heparin. Methods A prospective multicentre pilot study was performed. All patients undergoing elective open repair for an AAA (distal of the superior mesenteric artery) between March 2017 and January 2020 were included. Two heparin dosage protocols were compared: ACT-guided heparinization with an initial dose of 100 IU/kg versus a bolus of 5000 IU. The primary outcome was the effectiveness and feasibility of an ACT-guided heparinization protocol with an initial heparin dose of 100 IU/kg during open AAA surgery. Bleeding complications, TEC, and mortality were investigated for safety purposes. Results A total of 50 patients were included in the current study. Eighteen patients received a single dose of 5000 IU of heparin and 32 patients received 100 IU/kg of heparin with additional doses based on the ACT. All patients who received the 100 IU/kg dosing protocol reached the target ACT of > 200 s. In the 5000 IU group, TEC occurred in three patients (17%), versus three patients (9.4%) in the 100 IU/kg group. Bleeding complications were found in six patients (33%) in the 5000 IU group and in 9 patients (28%) in the 100 IU/kg group. No mortality occurred in either group. Conclusions This pilot study demonstrated that ACT-guided heparinization with an initial dose of 100 IU/kg appears to be feasible and leads to adequate anticoagulation levels. Further randomized studies seem feasible and warranted to determine whether ACT-guided heparinization results in better outcomes after open AAA repair.

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Section: Discussionmentioning

confidence: 99%

Activated clotting time-guided heparinization during open AAA surgery: a pilot study

Roosendaal,

Hoebink,

Wiersema

et al. 2024

Pilot Feasibility Stud

View full text Add to dashboard Cite

show abstract

“…In their investigation on the association between HR and postoperative problems in open heart surgery 18 , discovered that 4.3% of their patients had an ACT of less than 400 seconds after receiving 400 IU/kg heparin. FFP and AT-III are frequently utilised in the treatment of patients who develop HR.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Heparin resistance after preoperative heparin therapy in patients undergoing open heart surgery

Naeem¹,

Niazi²,

Muneeb³

et al. 2022

PJMHS

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Aim: Incidence of Heparin Resistance after preoperative heparin therapy in patients undergoing open heart surgery. Methods: The Prospective Observational study included 124 patients of different heart diseases undergoing open heart surgery, at cardiac surgery department of Punjab Institute of Cardiology; Lahore Pakistan was performed between 5th October 2013 to 16 March 2014. Both genders age 18-75 were included. All those patients who present with diseases other than heart diseases, age <18 and > 75 were excluded in the study. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16.0. P-value ≤ 0.05 were considered significant. Results: Our results showed that out of 124 patients, 87(70.16%) were male while 37(29.84%) were females. Clinical characteristics i.e. (hypertension, diabetes mellitus, emergency bypass, smoking, alcohol intake, hyperlipidemias, obesity and family history) were insignificantly associated with heparin resistance. The clinical characteristics i.e. (baseline activated clotting time, albumin and cross clamp time) were significantly associated with the development of heparin resistance as (p-value <0.05 .015, .041 and .025 respectively). Conclusion: The results indicate that the incidence of heparin resistance after preoperative heparin therapy was 8.06%.

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“…5) For our patient, the ACT was set to more than 200 seconds with reference to the value used in the intraoperative management of cardiac and vascular surgery. 6,7) Digestive reconstruction using the pediculate colon without revascularization was then started. As a result of the intraoperative administration of heparin, the reconstruction was a success, without thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Esophagectomy for Esophageal Cancer in a Patient with Protein C Deficiency: A Case Report

Ujiie

Taniyama

Okamoto

et al. 2020

ATCS

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Anticoagulant Effect of Standard Dose Heparin During Peripheral Endovascular Intervention

Cited by 9 publications

References 26 publications

Activated clotting time-guided heparinization during open AAA surgery: a pilot study

Activated clotting time-guided heparinization during open AAA surgery: a pilot study

Incidence of Heparin resistance after preoperative heparin therapy in patients undergoing open heart surgery

Esophagectomy for Esophageal Cancer in a Patient with Protein C Deficiency: A Case Report

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