Clinical experience with the activated clotting time for the control of heparin and protamine therapy during cardiopulmonary bypass

Akl, Bechara F.; Vargas, Giuseppe; Neal, James R.; Robillard, J; Pj, Kelly

doi:10.1016/s0022-5223(19)38010-9

Cited by 64 publications

(22 citation statements)

References 14 publications

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“…There are intrinsic biases built into some of the measurement devices, but repeatability within a given device is high. 2 ACT monitoring of heparinization has been criticized because of its high variability. 42 47 50 54 The main limiting factor is that it correlates poorly with anti-Xa measures of heparin activity, or with heparin concentration during CPB as a result of hypothermia and haemodilution.…”

Section: Heparin Monitoringmentioning

confidence: 99%

Point-of-care coagulation testing and transfusion algorithms

Enriquez

Shore‐Lesserson

2009

British Journal of Anaesthesia

103

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Patients with cardiovascular disease have an array of haemostasis disorders that predispose to the development of thrombotic and embolic disease states. These patients are often maintained on anti-thrombotic medication to prevent adverse cardiovascular events. Patients undergoing cardiac surgery also have haemostatic disorders that include their intrinsic disease state, adjunctive medication, and the coagulation disturbances induced by cardiopulmonary bypass. The following review introduces the monitors that are available for monitoring perioperative coagulation, with an emphasis on cardiovascular surgery. Heparin monitors, platelet function monitors for use in transfusion algorithms, and monitoring anti-platelet drugs will be discussed.

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Section: Heparin Monitoringmentioning

confidence: 99%

Point-of-care coagulation testing and transfusion algorithms

Enriquez

Shore‐Lesserson

2009

British Journal of Anaesthesia

103

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“…This phenomenon could lead to a thromboembolic event. Akl et al [10] proposed that the ACT may be determined by the metabolic rate of heparin, which could be affected by various factors, including different levels of sensitivity to heparin, cardiac output, total amount of blood supply, and perfusion velocity in each patient. Adhana et al [11] proved that bleeding time and clotting time were significantly higher in women than in men in their study of 200 healthy volunteers.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Difficult Reversal of Heparin by Protamine Sulfate in Cardiopulmonary Bypass: An Ignored Issue

Kim

Lee

et al. 2020

Korean J Thorac Cardiovasc Surg

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Background: The aim of this study was to evaluate risk factors associated with difficult heparin reversal by protamine after cardiopulmonary bypass. Methods: Data from 120 consecutive patients who underwent open heart surgery from 2009 to 2017 were retrospectively reviewed. Patients were divided into 2 groups: (1) those in whom complete heparin reversal was achieved after a single infusion of protamine (group A, n=89); and (2) those who required more protamine for heparin reversal (group B, n=31). Results: Female sex, prolonged bypass time (>200 min), long aortic cross-clamping time (>120 min), and a lowest rectal temperature <26°C were significant predictors of difficult heparin reversal. Larger amounts of fresh frozen plasma and platelet concentrate were transfused in group B than in group A. Conclusion: Surgeons' efforts to reduce operative time and avoid deep hypothermia may be helpful for increasing the likelihood of easy heparin reversal, especially in female patients.

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“…Heparin is the anticoagulant for CPB because of its prompt action, ease of neutralization with protamine sulfate, and cost. Heparin is important during CPB, [74][75][76][77][78][79] and its activity is measured by the ACT, a modified whole blood coagulation test that depends on an activator (kaolin or celite), and the intrinsic coagulation system as a monitor of anticoagulation. [80][81][82] However, the ACT does not reflect the circulating free heparin concentration.…”

Section: Anticoagulation For Cpbmentioning

confidence: 99%

“…[83][84][85] The ACT is routinely used to determine the adequacy of anticoagulation both before and during CPB. 83,86,87 Although there is controversy as to what the optimal ACT for CPB is, 75,88 400 to 480 seconds has been accepted. The lack of gross clot formation during CPB does not necessarily ensure thrombin inhibition, with subsequent activation of the coagulation cascade and platelets, depletion of clotting factors, and the initiation of fibrinolysis.…”

Section: Anticoagulation For Cpbmentioning

confidence: 99%

Recombinant Antithrombin: Production and Role in Cardiovascular Disorder

Levy¹,

Weisinger²,

Ziomek³

et al. 2001

Semin Thromb Hemost

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Plasma-derived antithrombin (AT) concentrates have been used for the management of hereditary and acquired deficiencies since the early 1980s. Recombinant versions of other blood factors and their derivatives are increasingly becoming available, providing a safe and abundant supply of these important therapeutics. However, the complexity of the AT molecule and the large doses often required for supplementation treatments preclude the use of traditional cell culture bioreactors for recombinant production. The development of a very efficient expression system has been necessary for the cost-efficient recombinant production of AT. Transgenic production, with its ability to yield high levels of heterologous protein and its scale-up flexibility, is an attractive alternative to plasma fractionation. Purification of recombinant AT from the milk of transgenic dairy goats has been developed to provide a homogeneous, well-defined, and abundant supply of this factor. This article describes the production of recombinant AT and aspects of clinical applications of this molecule to cardiovascular disorders.

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Clinical experience with the activated clotting time for the control of heparin and protamine therapy during cardiopulmonary bypass

Cited by 64 publications

References 14 publications

Point-of-care coagulation testing and transfusion algorithms

Point-of-care coagulation testing and transfusion algorithms

Risk Factors Associated with Difficult Reversal of Heparin by Protamine Sulfate in Cardiopulmonary Bypass: An Ignored Issue

Recombinant Antithrombin: Production and Role in Cardiovascular Disorder

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