Anticoagulation management during cross-clamping and bypass

Lander, Heather; Zammert, Martin; Fitzgerald, Daniel J.

doi:10.1016/j.bpa.2016.07.002

Cited by 18 publications

(24 citation statements)

References 67 publications

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“…Deep vein thrombosis prophylaxis measures such as preoperative low molecular weight heparin (LMWH) and contralateral elastic compression stockings are indicated. Anticoagulation is monitored throughout the procedure making sure that the activated clotting time (ACT) is always >350 ss [36].…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic hyperthermic isolated limb perfusion a new minimally invasive approach for HILP

Solari

Sucameli

Gipponi

et al. 2017

International Journal of Hyperthermia

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We describe for the first time an entirely laparoscopic HILP. Demonstration of this technique's efficacy and safety on a large series of patients is clearly necessary but its therapeutic efficacy appears to be comparable to the standard technique. Furthermore, laparoscopic HILP has shown low post-operative morbidity: no wound complications, mild and easily manageable post-operative pain and early discharge from the hospital and early resuming of daily activities.

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Section: Methodsmentioning

confidence: 99%

Laparoscopic hyperthermic isolated limb perfusion a new minimally invasive approach for HILP

Solari

Sucameli

Gipponi

et al. 2017

International Journal of Hyperthermia

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“…Safe conduct of CPB requires maximal inhibition of thrombin formation to prevent clot formation in the circuit or patients’ microvasculature, and to inhibit activation of the coagulation cascade . Unfractionated heparin (UFH) remains the anticoagulant of choice because of its reliable effectiveness, rapid onset, ease of reversibility and low cost . It also attenuates the activation of the contact pathway of coagulation by foreign surfaces better than other anticoagulants .…”

Section: Intraoperative Managementmentioning

confidence: 99%

“…Heparin exerts its primary anticoagulant effect by binding to AT, accelerating AT's inhibition of thrombin and other serine proteases (e.g. factors Xa and IXa) by ~1000‐fold . Heparin responsiveness is therefore heavily dependent on the concentration and function of plasma AT, which is negatively affected by several patient and surgery‐related factors, including liver disease (reduced AT production), developmental hemostasis (Table ), nephrotic disease (AT loss), hemodilution (decreased AT concentration), activation of coagulation as a result of sepsis, endocarditis, disseminated intravascular coagulation, venous thrombosis (increased AT consumption), and medications such as nitroglycerin .…”

Section: Intraoperative Managementmentioning

confidence: 99%

“…Nevertheless, standard practice is to use a weight‐based dosing strategy (e.g. 300–400 IU kg −1 initial bolus followed by 50–100 IU kg −1 every 30–120 min), aiming for an activated clotting time (ACT) of > 480 s . ACT is a point‐of‐care assay that assesses the effect of heparin by measuring the time to clot initiation of whole‐blood activated by contact with added reagents.…”

Section: Intraoperative Managementmentioning

confidence: 99%

“…First, the ‘safe’ ACT threshold for instituting CPB has not been defined and there remains wide variability in practice. The standard recommendation, which is based on limited data, is > 480 s . Second, ACT assays are not standardized and manufacturers use various methods for clot activation (e.g.…”

Section: Intraoperative Managementmentioning

confidence: 99%

See 2 more Smart Citations

Antithrombotic therapy management of adult and pediatric cardiac surgery patients

Kreuziger

Karkouti

Tweddell

et al. 2018

Journal of Thrombosis and Haemostasis

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Despite the development of catheter-based interventions for ischemic and valvular heart disease, hundreds of thousands of people undergo open heart surgery annually for coronary artery bypass graft (CABG), valve replacement or cardiac assist device implantation. Cardiac surgery patients are unique because therapeutic anticoagulation is required during cardiopulmonary bypass. Developmental hemostasis and altered drug metabolism affect management in children. This narrative review summarizes the current evidence-based and consensus guidelines regarding perioperative, intraoperative and postoperative antithrombotic therapy in patients undergoing cardiac surgery. Anticoagulation preoperatively is required in the setting of cardiac arrhythmias, prior valve replacement or history of venous thromboembolism. In patients with ischemic heart disease, aspirin is continued in the perioperative period, whereas oral P2Y antagonists are withheld for 5-7 days to reduce the risk of perioperative bleeding. Intraoperative management of cardiopulmonary bypass in adults and children includes anticoagulation with unfractionated heparin. Variability in dose-response to heparin and influence of other medical conditions on dosing and reversal of heparin make intraoperative anticoagulation challenging. Vitamin K antagonist therapy is the standard anticoagulant after mechanical heart valve or left ventricular assist device (LVAD) implantation. Longer duration of dual antiplatelet therapy is recommended after CABG if patients undergo surgery because of acute coronary syndrome. Antiplatelet therapy after LVAD implantation includes aspirin, dipyridamole and/or clopidogrel in children and aspirin in adults. A coordinated approach between hematology, cardiology, anesthesiology, critical care and cardiothoracic surgery can assist to balance the risk of thrombosis and bleeding in patients undergoing cardiac surgery.

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Inflammatory potential of cotton‐based surgically invasive devices: Implications for cardiac surgery

et al. 2018

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Cotton-based surgical invasive devices with their desired hemostyptic properties have been used for decades in the surgical field. However, in cardiac surgery using the heartlung machine with direct retransfusion of suction blood, activated blood may re-enter the circulation without filtration and may trigger a cascade reaction leading to systemic inflammation and thrombosis. We therefore set out to evaluate the inflammatory potential of untreated and pyrogen-impregnated cotton-based surgical invasive medical devices. After incubation of the swabs with whole blood or PBMC, the cell-free supernatant was investigated for IL1β and IL6. While the reaction of human whole blood toward cotton swabs could not be influenced by any sterilization technique, dry heat and gammairradiation were able to diminish the inflammatory reaction of PBMC toward the material and the used pyrogens. In conclusion, using PBMC in direct contact to cotton we are the first to establish a suitable test method for quantification of the pyrogenic/inflammatory activity of this material. The unaltered reaction of whole blood, however, suggests a crosstalk of cells and plasma proteins in the inflammation activation that is not prevented by sterilization of the swabs. This new in vitro testing methodology may help to better display the clinical situation during development of new materials.

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Anticoagulation management during cross-clamping and bypass

Cited by 18 publications

References 67 publications

Laparoscopic hyperthermic isolated limb perfusion a new minimally invasive approach for HILP

Laparoscopic hyperthermic isolated limb perfusion a new minimally invasive approach for HILP

Antithrombotic therapy management of adult and pediatric cardiac surgery patients

Inflammatory potential of cotton‐based surgically invasive devices: Implications for cardiac surgery

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