Evaluation of Tests Used to Monitor Heparin Therapy during Extracorporeal Circulation

Bull, Maureen H.; Huse, Wilfred M.; Bull, Brian S.

doi:10.1097/00000542-197509000-00012

Cited by 75 publications

(35 citation statements)

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“…As such, heparin is used extensively in the treatment of myocardial infarction, unstable angina, venous thrombosis, and pulmonary embolism (Hirsh et al, 2001). In addition, heparin is required to keep extracorporeal circulations during open heart surgery and renal dialysis (Bull et al, 1975;Ryckelynck et al, 1998). Commercially, heparin was isolated from bovine and porcine, after the outbreak of several contagious diseases and religious objections that has brought a need in search for alternative sources.…”

Section: A Carbohydrates Derivatives From Marine Fishmentioning

confidence: 99%

Therapeutic Drugs

Kumar¹,

Kumar²,

Jaiganesh³

2012

Marine Medicinal Foods - Implications and Applications - Animals and Microbes

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Section: A Carbohydrates Derivatives From Marine Fishmentioning

confidence: 99%

Therapeutic Drugs

Kumar¹,

Kumar²,

Jaiganesh³

2012

Marine Medicinal Foods - Implications and Applications - Animals and Microbes

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“…The ACT is a good reflection of high antithrombin (anti-IIa) activity. 6 Heparin concentration monitoring by POC tests is based on a protamine titration curve that evaluates the anti-IIa activity of heparin (anticoagulant activity). The "classic" heparin concentration test, done in coagulation laboratories and performed on plasma, measures the anti-Xa activity (antithrombotic activity) of UFH.…”

Section: Point-of-care (Poc) Heparin Monitoring During Cpbmentioning

confidence: 99%

“…3 The 480-sec threshold is based on an in vitro study. 6 Importantly, this arbitrary target of eight minutes was proposed for an instrument (the manual ACT) different from those used currently. The 400-sec target is supported by an animal study demonstrating that fibrin monomers were produced when the Hemochron® celite ACT was less than 400 sec.…”

Section: S90mentioning

confidence: 99%

“…5 Several authors failed to observe a correlation between the dose of UFH and the anti-Xa concentration or the ACT. [6][7][8][9][10] The pharmacokinetic and pharmacodynamic properties of UFH are highly variable, with large standard deviations, and show significant variations between individual responses according to inflammatory status, hepatic and renal functions. 1,11,12 Considering these large differences, an appropriate and individual monitoring of the anticoagulant effect of UFH is mandatory.…”

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confidence: 99%

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Antithrombotic therapy in cardiac surgery

Vincentelli

Jude

Bélisle

2006

Can J Anesth/J Can Anesth

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Purpose: To review the perioperative management of antithrombotic therapy in cardiac surgery, including the management of cardiopulmonary bypass (CPB) and off-pump surgery.Methods: A review of the relevant English literature over the period was undertaken, in addition to a review of international practices in antithrombotic therapy in cardiac surgery. Principal findings:Cardiopulmonary bypass is required in most procedures and makes anticoagulation mandatory. Anticoagulation is, usually, achieved with unfractionnated heparin (UFH). Unfractionated heparin is monitored by point-ofcare (POC) testing, such as the activated clotting time or the determination of heparin concentration. The target values of both tests remain empirical, with no clearly validated thresholds. The target value needs to be adjusted according to the POC test, given significant variations between devices and activators. After CABG, the need for antiplatelet therapy is well demonstrated, in order to limit the risk of postoperative death or ischemic events, and improve venous graft patency. Immediately after valvular surgery, antithrombotic therapy should take into account the specific risk carried by each patient and by each prosthetic device. The risk of venous thromboembolism, though poorly defined, is also present in the postoperative period and may require additional attention. Given the frequent exposure to UFH, occurrence of heparininduced thrombocytopenia is not infrequent in these patients and requires careful individual management. Conclusions:Antithrombotic therapy is an essential component of cardiac surgery. Yet, with the exception of antiplatelet agents in CABG patients, antithrombotic therapy is often based on the clinical experience of medical teams more than on an evidence-based assessment of the literature. Objectif Constatations principales : La circulation extracorporelle est nécessaire pour la majorité des opérations et rend l'anticoagulation obligatoire. L'anticoagulation est, habituellement, réalisée avec de l'héparine non fractionnée (HNF). L'HNF est contrôlée par des tests faits au chevet du malade comme le temps de coagulation activée ou la détermination de la concentration d'héparine. Les valeurs cible des deux tests demeurent empiriques, sans valeurs seuil clairement validées. La valeur cible doit être ajustée en fonction de chaque test de chevet à cause des variations significatives entre les instruments et les activateurs. Après le pontage aortocoronarien (PAC), la nécessité d'un traitement antiplaquettaire a été bien démontrée, qui vise à limiter les décès postopératoires ou les incidents ischémiques et à améliorer la

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“…Coagulation: Heparin at 300 units kg-a was given just before cannulation and then was given by continuous infusion to maintain the activated clotting time (ACT) [14,4] between 240 and 400 seconds; the actual dose of heparin ranged about 100 units kg-~hr-1. Blood hematocrit was measured by the microcentrifuge method.…”

Section: Blood Gasesmentioning

confidence: 99%

Hemodynamics and renal function during low frequency positive pressure ventilation with extracorporeal CO2 removal

et al. 1980

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Six lambs were anesthetized and connected venovenous mode to a Membrane Lung for Extracorporeal CO2 removal. The animals underwent several hours periods of continuous positive pressure ventilation (CPPV), at 5 cmH2O positive end expiratory pressure (PEEP), alternated with several hours periods of low frequency positive pressure ventilation (5 cmH2O PEEP, 2 b.p.m.) with extracorporeal CO2 removal (LFPPV-ECCO2R). During LFPPV-ECCO2R compared with CPPV, cardiac output increased by 26%, pulmonary vascular resistances and systemic vascular resistances decreased by 28% and 22% respectively. The renal function improved significantly during LFPPV-ECCO2R compared with CPPV, i.e. urinary flow, creatinine clearance and osmolar clearance increased by 50%, 37% and 52% respectively. In these experiments LFPPV-ECCO2R, a form of completely artificial ventilation, seems to prevent hemodynamic and renal complications of CPPV.

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Evaluation of Tests Used to Monitor Heparin Therapy during Extracorporeal Circulation

Cited by 75 publications

References 0 publications

Therapeutic Drugs

Therapeutic Drugs

Antithrombotic therapy in cardiac surgery

Hemodynamics and renal function during low frequency positive pressure ventilation with extracorporeal CO2 removal

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