Monitoring the Effect of Heparin Bolus during Percutaneous Coronary Angioplasty (PTCA): Assessment of Three Bedside Coagulation Monitors

Hézard, Nathalie; Metz, Damien; Potron, G; Nazeyrollas, Pierre; Maes, D; Mulpas, M. C.; Elaerts, J; Nguyen, P.

doi:10.1055/s-0037-1615377

Cited by 6 publications

(4 citation statements)

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“…We compared the assay results with those obtained using a laboratory APTT, ACT, Heptest, and anti-Xa. Unfortunately, we had to confirm previous findings that the APTT is unsuitable for monitoring the high doses of UFH required in patients undergoing angioplasty [18]. Although both APTT assays were very precise as measured by interassay correlation coefficients, the APTTs determined by both methods did not agree and cannot be used interchangeably (Figure 2).…”

Section: Abbildungmentioning

confidence: 88%

Laboratory Monitoring of Heparin and the Combination of Heparin and the Platelet Glycoprotein IIb/IIIa Receptor Antibody Fragment Abciximab (c7E3) in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty (PTCA)

Zahn

Haubelt²,

Bechtloff³

et al. 2003

Herz

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Section: Abbildungmentioning

confidence: 88%

Laboratory Monitoring of Heparin and the Combination of Heparin and the Platelet Glycoprotein IIb/IIIa Receptor Antibody Fragment Abciximab (c7E3) in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty (PTCA)

Zahn

Haubelt²,

Bechtloff³

et al. 2003

Herz

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“…In the therapeutic range, the mean difference in results between the two devices was 30%. 23 Another recent study, which compared two POC devices (Hemochron Response®, International Technidyne Corporation, Parker, CO, USA and Aktalike®, Array Medical, Somerville, NJ, USA) to the older Hemochron 801® showed that the ACTs measured with the Aktalike® were 18% shorter than those measured with the Hemochron 801® (P = 0.0001). 24 The ability to detect a clot in the blood sample is, obviously, different between instruments and has an impact on the final result.…”

Section: S90mentioning

confidence: 99%

“…28 When aprotinin is used during CPB, the recommended empirical target value for the celite ACT is at least 750 sec, while it is 450 sec for the kaolin-ACT. 23 It is important to note that the target of 750 sec is based on in vitro data and that the threshold of 450 sec for the kaolin-ACT has not been validated by clinical studies. 29 Tranexamic acid does not modify ACT values, making anticoagulation easier to manage when POC monitors are used to monitor heparin effect.…”

Section: S90mentioning

confidence: 99%

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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“…CoaguChek ® Pro), der Hemochron ® und der TAS (10). Die POCT-Bestimmung der aPTT ist nicht unproblematisch und deren Zuverlässigkeit und Nutzen wird unterschiedlich beurteilt (11)(12)(13)(14). (16,17).…”

Section: Kontrolle Der Heparinisierungunclassified

»Point-of-care Testing« Vollblutmethoden in der Hämostasediagnostik

Wuillemin¹

2000

Hamostaseologie

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ZusammenfassungPoint-of-care-Tests (POCT) mit Vollblut gibt es für verschiedene Analysen im Bereich der Hämostase. Am häufigsten wird die Thromboplastinzeit mit Kapillarblut durchgeführt. Diese POCT-Analyse ist zuverlässig und wird u. a. bei der Patientenselbstkontrolle der oralen Antikoagulation eingesetzt. Die aPTT als POCT ist teilweise problematisch, deren Einsatz muß kritisch erwogen werden. Der PFA-100-Analyser ist geeignet als Screeningtest für Thrombozytopathien und ausgeprägte Von-Willebrand-Faktor-Mangelzustände. Die D-Dimer-Teste mit Vollblut erfüllen die Anforderungen bezüglich hoher Sensitivität nicht immer.Die Einsatzmöglichkeiten der Hämostase-POCT-Analysen müssen kritisch und wissenschaftlich definiert werden. Diverse Aspekte wie Qualitätskontrolle, Kosten und Gewinnung der Vollblut-Proben müssen weiter bearbeitet werden.

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Monitoring the Effect of Heparin Bolus during Percutaneous Coronary Angioplasty (PTCA): Assessment of Three Bedside Coagulation Monitors

Cited by 6 publications

References 0 publications

Laboratory Monitoring of Heparin and the Combination of Heparin and the Platelet Glycoprotein IIb/IIIa Receptor Antibody Fragment Abciximab (c7E3) in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty (PTCA)

Laboratory Monitoring of Heparin and the Combination of Heparin and the Platelet Glycoprotein IIb/IIIa Receptor Antibody Fragment Abciximab (c7E3) in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty (PTCA)

Antithrombotic therapy in cardiac surgery

»Point-of-care Testing« Vollblutmethoden in der Hämostasediagnostik

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