Variability of the Activated Coagulation Time

Gp, Gravlee; Ld, Case; Kc, Angert; At, Rogers; Gs, Miller

doi:10.1213/00000539-198805000-00010

Cited by 65 publications

(32 citation statements)

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“…Cette formule a été retenue afin de comparer nos résultats à ceux rapportés par Gravlee et coll. 27 L'analyseur SCT et le TEG permettent de classifier les individus en trois classes fonctionnelles selon leur état hémostatique. Pour le TEG, cette classification est basée sur la valeur de l'indice de coagulation (mesuré par l'appareil) dont les valeurs normales fournies par le constructeur sont comprises entre -2 et +2.…”

Section: Analyses Statistiquesunclassified

“…Ces résultats sont comparables avec ceux de Gravlee et coll., 27 les pourcentages de variation de l'ACT-C (obtenus selon la même formule de calcul) variaient entre 3,1 % et 3,9 % pour les échantillons sanguins non héparinisés, et augmentaient jusqu'à 7,8 % pour les échantillons sanguins héparinisés avant la CEC. Toutefois, dans cette étude, aucun échantillon n'était prélevé durant la CEC, une condition d'utilisation courante en clinique.…”

Section: Comparaison De L'indice De Coagulation Mesuré Par Le Teg Dunclassified

“…Gravlee et coll. 27 rapportent un coefficient de variation de 4 % et de 7,8 % pour l'ACT d'échantillons de sang non-héparinisé et héparinisé respectivement. LaForce et coll.…”

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Reproductibilité et interchangeabilité du Thromboélastographe®, Sonoclot® et du temps de coagulation activé (Hémochron®), en chirurgie cardiaque

Forestier

Bélisle

Contant³

et al. 2001

Can J Anesth/J Can Anesth

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O Ob bj je ec ct ti if f : : Malgré une utilisation courante, la reproductibilité des mesures du Thromboélastographe® (TEG), du Sonoclot® (SCT), et de l Hémochron® mesurant le temps de coagulation activé avec célite ou kaolin (ACT-C et ACT-K), a été peu étudiée dans les conditions réelles d utilisation. La présente étude évalue la reproductibilité de ces mesures, et la possibilité de substituer l ACT-C par un des autres tests. Methods: Blood samples collected from 20 volunteers and 21 patients undergoing myocardial revascularization were analyzed in the two channels of the TEG, in two SCT and four Hemochron® analyzers. The overall of TEG and SCT coagulation profiles were analyzed by a computerized TEG and an experienced observer respectively. The variation rate (V%) was calculated for each variable. The ability of ACT-K and SCT to substitute for ACT-C under different clinical conditions was evaluated.Results: ACT-C and ACT-K V% ranged between 5.6% and 10.8% and between 6.7% and 12.4% respectively. TEG and SCT V% ranged between 3.1% and 9.5% and between 5.8% and 33.6% respectively, according to different conditions and parameters. In volunteers and nonheparinized patients, the ACT-C and ACT-K were interchangeable. No other test can substitute for the ACT-C when patients are heparinized during cardiopulmonary bypass (CPB). Conclusions:In the clinical conditions of use, on-site hemostasis monitoring devices providing the most reproducible measurements are, in decreasing order, the TEG, the Hemochron® and the SCT. In heparinized patients and during CPB, results from different tests are not interchangeable, stressing the importance of establishing appropriate instrument-specific values for monitoring anticoagulation during cardiac surgery.

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Section: Analyses Statistiquesunclassified

Section: Comparaison De L'indice De Coagulation Mesuré Par Le Teg Dunclassified

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Reproductibilité et interchangeabilité du Thromboélastographe®, Sonoclot® et du temps de coagulation activé (Hémochron®), en chirurgie cardiaque

Forestier

Bélisle

Contant³

et al. 2001

Can J Anesth/J Can Anesth

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“…A target value of 400-480 sec has been proposed only for the Hemochron®-based instrument. 16 Modifications of the blood salvage procedure (avoiding the re-infusion of shed mediastinal blood, or return after washing and centrifugation via a cell-saving device) or the use of heparin-bound circuits could limit blood activation and reduce the amount of heparin required. [17][18][19][20][21] The ACT values obtained by different monitors or with different activators cannot be interchanged, particularly during anticoagulation with heparin.…”

Section: S90mentioning

confidence: 99%

“…These studies should also take into account the important variation of the results obtained during CPB or off bypass surgery and differences between devices and activators. 16 Until randomized clinical trials become available, the clinician will have to apply an empirical threshold, adapted to the POC monitor being used.…”

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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Hemostatic effects of low-dose protamine following cardiopulmonary bypass

et al. 2000

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Twenty-eight patients undergoing cardiac surgery were prospectively studied and were assigned to two groups. The patients received 0.8-(Group L) or 2.0-fold (Group H) dose of protamine for the neutralization after cardiopulmonary bypass (CPB) which was determined by Hepcon HMS assay system in which the reagent chamber containing the concentration of protamine that completely neutralized the heparin had the shortest clotting time. Mean dose of protamine was 1.60 ± 0.50 mg kg −1 in Group L, and 3.56 ± 1.48 mg kg −1 , respectively. Activated clotting times (ACT) were comparable between the two groups through this study period. In Group H, platelet counts significantly decreased to 69% of that before protamine administration, and plasma platelet factor 4 level significantly increased to approximate 2-fold of that before protamine administration just after protamine administration, respectively. However, these phenomena were not observed in Group L. In addition, these hemostatic changes occurred transiently just after protamine administration. We conclude that the low-dose protamine may prevent transient platelet depletion following CPB. Low-dose protamine can neutralize anticoagulation effect of heparin sufficiently and may mitigate protamine-induced platelet dysfunction. Am.

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Variability of the Activated Coagulation Time

Cited by 65 publications

References 0 publications

Reproductibilité et interchangeabilité du Thromboélastographe®, Sonoclot® et du temps de coagulation activé (Hémochron®), en chirurgie cardiaque

Reproductibilité et interchangeabilité du Thromboélastographe®, Sonoclot® et du temps de coagulation activé (Hémochron®), en chirurgie cardiaque

Antithrombotic therapy in cardiac surgery

Hemostatic effects of low-dose protamine following cardiopulmonary bypass

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