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

Abstract

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.

Conventional Weight-Based versus Low-Dose Regimen of Heparin Administration to Achieve Target Activated Clotting Time on Cardiopulmonary Bypass in Pakistani Population

“…3,5 There are studies that show reduced incidence of perioperative bleeding, when Heparin administration is monitored with ACT. 8,9 Lower ACT values are associated with high risk of thrombus formation in the extra-corporeal circuit, and higher values may lead to excessive perioperative bleeding. 9,10 It is therefore recommended to achieve safe target ACT, before CPB.…”

“…8,9 Lower ACT values are associated with high risk of thrombus formation in the extra-corporeal circuit, and higher values may lead to excessive perioperative bleeding. 9,10 It is therefore recommended to achieve safe target ACT, before CPB.…”

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

“…In this study, greater amounts of fresh frozen plasma and platelet concentrate were required for group B than for group A (p=0.014 and p=0.021, respectively). Ozkan et al [12] retrospectively compared patients who underwent open heart surgery whose ACTs were 400-650 seconds with those with ACTs of 650 seconds or higher during CPB. They reported that drainage on postoperative day 1 (p=0.000), the postoperative blood transfusion amount (p=0.010), and intensive care duration (p=0.0015) were more favorable in the group with an ACT range during CPB of 400-650 seconds.…”