Heparin Dosing and Monitoring for Cardiopulmonary Bypass. A Comparison of Techniques with Measurement of Subclinical Plasma Coagulation

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

“…76 Moreover, the transfusion rate at day 7 was 84%, with platelets (mean of 8.6 ± 7.2 concentrates/patient, range 1-23) being the blood component used most often. 76 Each transfused patient also received FFP and PRBC (mean of 6.0 ± 4.7 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] and 5.6 ± 3.8 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16], respectively). 76 The CHOOSE-OFF trial was a prospective, multicentre, open-label study with no comparator arm assessing bivalirudin anticoagulation in OPCAB patients with confirmed or prior HIT/thrombotic syndrome (HIT/TS) and/or anti-PF4/UFH antibodies.…”

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…358,359 Studies in adults using ACT alone or combined with heparin concentration assays compared with empirical dosing demonstrate that these tests generally either result in a decrease in postoperative bleeding or transfusion requirements or at worst have neutral results, suggesting that the use of these tests to guide heparin therapy is probably beneficial. [360][361][362][363][364][365][366][367][368][369][370][371][372][373][374][375][376][377] The anticoagulation strategies for children are borrowed from the adult experience, and few studies address the pediatric age range specifically, despite the fact that factors known to prolong ACT, such as hypothermia, hemodilution, and decreased platelet function, are prevalent in pediatric cardiac operations. The optimal target ACT that will prevent clot formation within the CPB circuit is not precisely known, but clot formation is unlikely with an ACT >300 seconds.…”

Heparina de alto peso molecular. Uma alternativa nas operações com circulação extracorpórea: estudo experimental

“…No experimento, 6,78% da heparina não foi neutralizada no grupo da HAPM contra 7,84% na HNF. A implicação clínica disto é que as HBPM ficam circulando (48) , saem pelo dreno (36) e podem ter sido as responsáveis pelo maior sangramento nos casos em que foram utilizadas em circulação extracorpórea (9,10) , e a causa do sangramento "inexplicável", pós-operatório, maior, nos casos descritos com altas doses de HNF (49,50) .…”

“…No pós-operatório dessas operações, parte das síndromes hemorrágicas pode ser atribuída à heparinização. Acreditando que o sangramento ocorria pela anticoagulação sangüínea (18) , várias tentativas foram preconizadas, desde o acerto de doses menores, controladas rigorosamente com o TCA (49,50) , até o uso de drogas sintéticas. Estamos convencidos de que a neutralização da ação anticoagulante com protamina é importante para diminuir a drenagem pós-operatória (51) .…”