Anticoagulation management during cardiopulmonary bypass: A survey of 54 North American institutions

Lobato, Robert L.; Despotis, George J.; Levy, Jerrold H.; Shore‐Lesserson, Linda; Carlson, Melvin O.; Bennett‐Guerrero, Elliott

doi:10.1016/j.jtcvs.2010.02.038

Cited by 53 publications

(31 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…and 95% confidence intervals the surgical tissue manipulation. In operations where cardiopulmonary bypass is used, activation of coagulation (only partially suppressed by heparin) occurs related to the contact of blood with foreign, non-endothelial surfaces and consequent activation of the fibrinolytic system is described [13][14][15][16]. Re-infusion of the suctioned fluids from the surgical field thereafter enhances these pathological processes [17].…”

Section: Discussionmentioning

confidence: 99%

Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study

Spegar

Vanek

Snircova

et al. 2011

J Thromb Thrombolysis

View full text Add to dashboard Cite

The study was performed to examine a possible augmentation of systemic administration of tranexamic acid by the additional topical application during heart valve surgery in the post-aprotinin era. One-hundred patients were enrolled in the study and all the patients were given tranexamic acid intravenously. The participants were randomized into two groups (A, n = 49; B, n = 51), and before commencing the sternal suturing, the study solution (group A: 250 ml of normal saline + tranexamic acid 2.5 g, placebo group B: 250 ml of normal saline) was poured into the pericardial cavity. The cumulative blood loss (geometric means [95% confidence intervals]) 4 h after the surgery was 86.1 [56.1, 132.2] ml in group A, and 135.4 [94.3, 194.4] in group B, test for equality of geometric means P = 0.107, test for equality of variances P = 0.059. Eight hours after the surgery, the blood loss was 199.4 [153.4, 259.2] ml in group A, 261.7 [205.1, 334.0] ml in group B, P = 0.130 and P = 0.050, respectively. Twenty-four hours postoperatively the blood loss was 504.2 [436.0, 583.0] ml in group A, 569.7 [476.0, 681.7] ml in group B, P = 0.293 and P = 0.014, respectively. The proportion of patients transfused postoperatively by fresh frozen plasma differed significantly between the two study groups (group A: n = 21, group B: n = 36, P = 0.008). Our hypothesis is supported by a significant difference in the inter-group variance of blood loss and the proportion of patients requiring fresh frozen plasma; however evident differences in mean postoperative blood loss were not statistically significant.

show abstract

Section: Discussionmentioning

confidence: 99%

Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study

Spegar

Vanek

Snircova

et al. 2011

J Thromb Thrombolysis

View full text Add to dashboard Cite

show abstract

“…The most successful approach to date has been to chemically immobilize heparin on blood-contacting surfaces to reduce thrombosis and lower anticoagulant administration 9,10 . Although this approach has been widely adopted, major limitations persist because the surface-bound heparin leaches, resulting in a progressive loss of anticoagulation activity 4,11 and the use of heparin-coated materials has not led to a drastic reduction in the clinical use of soluble heparin 12 . Some high-flow dialysis treatments can be carried out without heparin in subsets of patients with high bleeding risks, but even in this patient population, half are forced to switch to heparin bolus dialysis within the first year of treatment 2 .…”

Section: ____________________________________________________________mentioning

confidence: 99%

A bioinspired omniphobic surface coating on medical devices prevents thrombosis and biofouling

et al. 2014

View full text Add to dashboard Cite

________________________________________________________________Countless lives have been saved by implantable medical devices (e.g., total artificial hearts, ventricular assist devices, pacemakers, cardioverterdefibrillators, and central lines) and extracorporeal devices that flow whole human blood outside the body through indwelling catheters and external circuits, during cardiopulmonary bypass (CPB), hemodialysis, and extracorporeal membrane oxygenation (ECMO) 1,2 . However, the need to co-administer soluble anticoagulant drugs, such as heparin, with many of these procedures, significantly reduces their safety and hampers their effectiveness 3,4 . Without systemic anticoagulation, these extracorporeal and indwelling devices can rapidly occlude due to thrombosis because clots form when fibrin and platelets in the flowing blood adhere to the surfaces of these artificial materials 5 . Unfortunately, heparin causes significant morbidity and mortality including post-operative bleeding, thrombocytopenia, hypertriglyceridemia, hyperkalemia and hypersensitivity 6 , and its use is contraindicated in several patient populations 7 . In fact, the majority of drug-related deaths from adverse clinical events in the UnitedStates are due to systemic anticoagulation 8 .This need to prevent blood clotting while minimizing administration of anticoagulant drugs has led to the search for biomaterial surface coatings that can directly suppress blood clot formation. The most successful approach to date has been to chemically immobilize heparin on blood-contacting surfaces to reduce thrombosis and lower anticoagulant administration 9,10 . Although this approach has been widely adopted, major limitations persist because the surface-bound heparin leaches, resulting in a progressive loss of anticoagulation 24,25 . Importantly, the TP continues to retain the free LP as a thin mobile liquid layer even when the surface is challenged with a flowing immiscible fluid, such as blood (Fig. 1a). We refer to this unique anti-thrombogenic bilayer composed of the TP and LP coating as a Tethered-Liquid Perfluorocarbon (TLP) surface. RESULTS A generic blood repellent surface coatingTo test the anti-adhesive properties of the TLP coating method, we examined surface adhesion of fresh whole human blood on an acrylic surface sloped at an angle of 30 degrees, with or without a TLP coating composed of tethered perfluorohexane and liquid perfluorodecalin. Blood droplets immediately adhered to the control uncoated acrylic surface and left a trail of blood components over the course of 5 sec (Fig. 1b, top, Supplementary Fig. 1 and Supplementary Movie 1).In contrast, when the same surface was coated with TLP, the blood droplet almost immediately slid off the surface (< 0.3 sec), and remarkably, there was no evidence of any residual blood trail (Fig. 1b, Supplementary Fig. 1 and Supplementary Movie 2). We quantified blood adhesion to surfaces by measuring the minimum angle required to cause a droplet to slide ("sliding angle") ( Fig. 1c). Control uncoated s...

show abstract

“…(20,21) A study shows us most clinics in USA and Canada targets 400-480 seconds of ACT during CPB . (11) Under coagulation during CBP can result with thromboembolic events on the contrary over coagulation can result with non-surgery related bleeding and increased post-operative drainage and need of blood transfusion. During CBP most frequently used method is ACT but there is not a universal ideal ACT level (11,12) even so an empiric 300 IU/kg dose of heparin to inhibit coagulation during CPB is widely accepted.…”

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

Anticoagulation management during cardiopulmonary bypass: A survey of 54 North American institutions

Cited by 53 publications

References 5 publications

Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study

Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study

A bioinspired omniphobic surface coating on medical devices prevents thrombosis and biofouling

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

Contact Info

Product

Resources

About