Sustained heparin effect contributes to reduced plasma thrombin generation capacity early after cardiac surgery

Radulovic, Vladimir; Hyllner, Monica; Ternström, Lisa; Karlsson, MariAnne; Bylock, Anders; Hansson, Kenny M.; Baghaei, Fariba; Jeppsson, Anders

doi:10.1016/j.thromres.2011.12.025

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…Reference tests for vWF, factor Xa activity and ETP also failed to improve discrimination. These results address conflicting evidence from previous small studies that have considered the interaction between these measures and bleeding, 77,158,159 although all of these studies were at high risk of bias. A low recombinant factor XIII level has also been shown to be associated with coagulopathic bleeding in previous studies.…”

Section: Laboratory Reference Testssupporting

confidence: 64%

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Murphy

Mumford

Rogers

et al. 2017

Programme Grants Appl Res

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This report should be referenced as follows:Murphy GJ, Mumford AD, Rogers CA, Wordsworth S, Stokes EA, Verheyden V, et al. Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials. Programme Grants Appl Res 2017;5(17). Programme Grants for Applied ResearchISSN 2050-4322 (Print) ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10384. The contractual start date was in July 2008. The final report began editorial review in July 2016 and was accepted for publication in April 2017. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not ...

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Section: Laboratory Reference Testssupporting

confidence: 64%

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Murphy

Mumford

Rogers

et al. 2017

Programme Grants Appl Res

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“…Tailoring drug dosages to fit the needs of individual patients could be helpful to make old and new drugs more effective and safer . Preliminary observations showed that thrombin generation testing is affected by all anticoagulant drugs and therefore it could be the candidate assay . The test has been found to be very sensitive to all kind of anticoagulants and may best represent the interindividual response than just exploring plasma drug concentrations .…”

Section: Discussionmentioning

confidence: 99%

Assessment of the analytical performances and sample stability on ST Genesia system using the STG‐DrugScreen application

Douxfils

Morimont

Bouvy³

et al. 2019

Journal of Thrombosis and Haemostasis

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This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. AbstractBackground: Thrombin generation testing has been used to provide information on the coagulation phenotype of patients. The most used technique is the calibrated automated thrombogram (CAT) but it suffers from a lack of standardization, preventing its implementation in routine. The ST Genesia is a new analyzer designed to assess thrombin generation based on the same principle as the CAT. Unlike the CAT system, the ST Genesia is a benchtop, fully automated analyzer, able to perform the analyses individually and not by batch, with strict control of variables such as temperature and volumes, ensuring, theoretically, maximal reproducibility. Objectives:This study aimed at assessing the performance of the STG-DrugScreen application on the ST Genesia analyzer. We also aimed at exploring stability of plasma samples after freezing and defining a reference normal range. Results:Results demonstrated the excellent interexperiment precision of the ST Genesia and confirmed that the use of a reference plasma helps reducing the

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“…Both reduced thrombin generation, impaired clot formation and reduced platelet function may contribute [ 6 – 8 ]. In standard cardiac surgery settings, we [ 9 ] and others [ 10 – 12 ] have found markedly decreased plasma potential to generate thrombin shortly after surgery, as determined by the calibrated automated thrombography (CAT) assay [ 13 ]. The reduced thrombin generation potential after surgery has been linked to increased postoperative bleeding [ 6 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…The reduced thrombin generation potential after surgery has been linked to increased postoperative bleeding [ 6 , 14 ]. Low thrombin generation potential after surgery has previously been associated with residual heparin effect [ 9 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Heparin and Protamine Titration Does Not Improve Haemostasis after Cardiac Surgery: A Prospective Randomized Study

et al. 2015

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BackgroundBleeding complications are common in cardiac surgery. Perioperative handling of heparin and protamine may influence the haemostasis. We hypothesized that heparin and protamine dosing based on individual titration curves would improve haemostasis in comparison to standard dosing.Subjects and MethodsSixty patients scheduled for first time elective coronary artery bypass grafting or valve surgery were included in a prospective randomized study. The patients were randomized to heparin and protamine dosing with Hepcon HMS Plus device or to standard weight and activated clotting time (ACT) based dosing. Blood samples were collected before and 10 minutes, 2 hours and 4 hours after cardiopulmonary bypass. Primary endpoint was endogenous thrombin potential in plasma 2 hours after surgery as assessed by calibrated automated thrombography. Secondary endpoints included total heparin and protamine doses, whole blood clot formation (thromboelastometry) and post-operative bleeding volume and transfusions. Heparin effect was assessed by measuring anti-Xa activity.ResultsEndogenous thrombin potential and clot formation deteriorated in both groups after surgery without statistically significant intergroup difference. There were no significant differences between the groups in total heparin and protamine doses, heparin effect, or postoperative bleeding and transfusions at any time point. Significant inverse correlations between anti-Xa activity and endogenous thrombin potential were observed 10 min (r = -0.43, p = 0.001), 2 hours (r = -0.66, p<0.001) and 4 hours after surgery (r = -0.58, p<0.001).ConclusionIn conclusion, the results suggest that perioperative heparin and protamine dosing based on individual titration curves does not improve haemostasis after cardiac surgery. Postoperative thrombin generation capacity correlates to residual heparin effect.Trial Registration www.isrctn.com ISRCTN14201041.

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Sustained heparin effect contributes to reduced plasma thrombin generation capacity early after cardiac surgery

Cited by 12 publications

References 24 publications

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Assessment of the analytical performances and sample stability on ST Genesia system using the STG‐DrugScreen application

Heparin and Protamine Titration Does Not Improve Haemostasis after Cardiac Surgery: A Prospective Randomized Study

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