Clinical monitoring of activated clotting time during cardiothoracic surgery: comparing the Hemochron^® Response and Hemochron^® Signature Elite

Abstract

Introduction: The Activated Clotting Time (ACT) is commonly used to manage anticoagulation during cardiac surgery. The aim of this study was to compare the older manually operated Hemochron® Response and the automated Hemochron® Signature Elite. Methods: In this observational study the clinically relevant differences of both devices were investigated simultaneously, using duplicate measurements, in 29 patients who underwent a Coronary Artery Bypass Grafting (CABG) or Aortic Valve Replacement (AVR) in order to determine reliability, bias, and to detect which method has the lowest variation. Blood samples were obtained from the arterial line prior to surgery, after administration of 300 IU/kg heparin, 5 minutes after initiation of cardiopulmonary bypass and successively every 30 minutes, and after protamine administration. Results: A total of 202 measurements were performed. Of these 10 measurements were out of range in the Response and 9 in the Elite. About 27 single unstable magnet errors were seen in the Response versus no measurement errors in the Elite. No statistically significant differences between the Response (p = 0.22, Wilcoxon rank) and Elite (p = 0.064) duplicates were observed. The Response values were consistently higher during heparinization than the Elite measurements (p = 0.002, repeated measurements) with an average positive bias of around 56 seconds during heparinization (Bland-Altman). Overall, the coefficient of variation (CoV) increased during heparinization. Conclusion: The Elite was more reliable, but the variation was higher for the Elite than the Response. The observed positive bias in the Response compared to the Elite could affect heparin administration during surgery making the two systems not interchangeable.

Comparison of Two Techniques of Measuring Activated Clotting Time During Cardiac Surgery

“…They concluded that results of devices with different mecha-nisms should not be used interchangeably. [17][18][19] These study agree with our findings that devices having different mechanisms of measurement show difference in results. These results should not be used interchangeably and same device should be used before and after heparin administration and till the correction of ACT by protamine.…”

In Vivo Effects of Balanced Crystalloid or Gelatine Infusions on Functional Parameters of Coagulation and Fibrinolysis: A Prospective Randomized Crossover Study

“…The use of functional point-of-care tests also supports the rational disposition of blood products, and thromboelastometry, thromboelastography, alongside activated clotting time are among the most commonly utilized POCTs in the operating room environment. [ 43 , 44 , 45 ].…”