Weight Based Heparin Dosage with Activated Clotting Time Monitoring Leads to Adequate and Safe Anticoagulation in Non-Cardiac Arterial Procedures

Doganer, Orkun; Roosendaal, Liliane C.; Wiersema, Arno M.; Blankensteijn, Jan D.; Yeung, Kak Khee; Jongkind, Vincent

doi:10.1016/j.avsg.2022.01.029

Cited by 7 publications

(3 citation statements)

References 29 publications

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“…Although the optimal target ACT has not been set in guidelines, research suggests an ACT between 200 and 250 s may be preferable during NCAP, to minimize the TEC risk without compromising procedural success or increasing bleeding complications [ 37 , 38 ]. Previous studies on heparinization during NCAP found a lower incidence of TEC in patients receiving an ACT-guided heparinization protocol (9%) compared to a single heparin bolus of 5 000 IU (4.3%) [ 4 , 21 ]. In addition, the ACT-guided heparinization protocol, similar to the 100 IU/kg protocol used in the current study, proved to be feasible and safe during NCAP, with more patients reaching an ACT > of 200 s [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is in contrast to NCAP, where a single bolus of 5000 IU of heparin without monitoring the effect of heparin is most often used [ 20 ]. Results from previous cohort studies suggest that ACT-guided heparinization may potentially lead to a lower incidence of TEC [ 21 ]. Large comparative studies are lacking, however, and published studies often have heterogeneous procedure types.…”

Section: Introductionmentioning

confidence: 99%

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Activated clotting time-guided heparinization during open AAA surgery: a pilot study

Roosendaal,

Hoebink,

Wiersema

et al. 2024

Pilot Feasibility Stud

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Background Arterial thrombo-embolic complications (TEC) are still common during and after non-cardiac arterial procedures (NCAP). While unfractionated heparin has been used during NCAP for more than 70 years to prevent TEC, there is no consensus regarding the optimal dosing strategy. The aim of this pilot study was to test the effectiveness and feasibility of an activated clotting time (ACT)-guided heparinization protocol during open abdominal aortic aneurysm (AAA) surgery, in anticipation of a randomized controlled trial (RCT) investigating if ACT-guided heparinization leads to better clinical outcomes compared to a single bolus of 5000 IU of heparin. Methods A prospective multicentre pilot study was performed. All patients undergoing elective open repair for an AAA (distal of the superior mesenteric artery) between March 2017 and January 2020 were included. Two heparin dosage protocols were compared: ACT-guided heparinization with an initial dose of 100 IU/kg versus a bolus of 5000 IU. The primary outcome was the effectiveness and feasibility of an ACT-guided heparinization protocol with an initial heparin dose of 100 IU/kg during open AAA surgery. Bleeding complications, TEC, and mortality were investigated for safety purposes. Results A total of 50 patients were included in the current study. Eighteen patients received a single dose of 5000 IU of heparin and 32 patients received 100 IU/kg of heparin with additional doses based on the ACT. All patients who received the 100 IU/kg dosing protocol reached the target ACT of > 200 s. In the 5000 IU group, TEC occurred in three patients (17%), versus three patients (9.4%) in the 100 IU/kg group. Bleeding complications were found in six patients (33%) in the 5000 IU group and in 9 patients (28%) in the 100 IU/kg group. No mortality occurred in either group. Conclusions This pilot study demonstrated that ACT-guided heparinization with an initial dose of 100 IU/kg appears to be feasible and leads to adequate anticoagulation levels. Further randomized studies seem feasible and warranted to determine whether ACT-guided heparinization results in better outcomes after open AAA repair.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Activated clotting time-guided heparinization during open AAA surgery: a pilot study

Roosendaal,

Hoebink,

Wiersema

et al. 2024

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

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“…Therefore, we used weight-based heparin dosing during surgery. 9 ) This strategy avoided the use of argatroban hydrate, which carries a high risk of bleeding and requires frequent anticoagulation testing using ACT during surgery. 5 , 6 ) However, intraoperative heparin administration may cause platelet activation and subsequent heparin resistance.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Aortic Aneurysm with Essential Thrombocythemia: A Case Report Describing Perioperative Management in Open Surgery

Yamamoto¹,

Onoda²

2023

Annals of Vascular Diseases

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We report perioperative management and open surgery to treat a case of infrarenal abdominal aortic aneurysm with essential thrombocythemia (ET), a chronic myeloproliferative disorder associated with arterial or venous thrombosis, idiopathic bleeding, and heparin-resistant diathesis. Following careful preoperative management, including assessment of heparin resistance, open surgery was successfully performed to treat the aortic aneurysm of our patient. This report shows that optimal preparation for surgery is important to safely perform abdominal aortic aneurysm repair and prevent perioperative thrombosis and bleeding in patients with abdominal aortic aneurysm with ET.

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Ability of Activated Clotting Time Measurements to Monitor Unfractionated Heparin Activity During NonCardiac Arterial Procedures

Hoebink,

Steunenberg,

Roosendaal

et al. 2025

Annals of Vascular Surgery

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Weight Based Heparin Dosage with Activated Clotting Time Monitoring Leads to Adequate and Safe Anticoagulation in Non-Cardiac Arterial Procedures

Cited by 7 publications

References 29 publications

Activated clotting time-guided heparinization during open AAA surgery: a pilot study

Activated clotting time-guided heparinization during open AAA surgery: a pilot study

Abdominal Aortic Aneurysm with Essential Thrombocythemia: A Case Report Describing Perioperative Management in Open Surgery

Ability of Activated Clotting Time Measurements to Monitor Unfractionated Heparin Activity During NonCardiac Arterial Procedures

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