Anticoagulation management in patients undergoing open heart surgery by activated clotting time and whole blood heparin concentration

Federico, Pappalardo; Annalisa, Franco; Giuseppe, Crescenzi; Francesco, De Simone; Lucia, Torracca; Alberto, Zangrillo
September 2006
Perfusion;Sep2006, Vol. 21 Issue 5, p285
Academic Journal
Objective: To investigate the changes in perioperative anticoagulation management using a heparin-concentration-based system (HMS), and its effect on postoperative outcome. Methods: A total of 39 patients undergoing elective primary open heart surgery were randomly assigned to a heparin-concentration-based system approach (study group: 17 patients) or a standard ACT-based anticoagulation system (control group: 22 patients). Measurements and main results: Patients in the study group received a statistically significant higher dose of heparin (median 29 000 IU with IQR 22 500–33 500 IU versus median 19 000 IU with IQR 17 775–21 500 IU; p <0.001) and a smaller dose of protamine (median 170 mg with IQR 145–190 mg versus median 200 mg with IQR 180–250 mg; p =0.008) compared to the control group. Postoperative platelet count was significantly higher in the study group (164±45 × 109 /L versus 125± 27 × 109 /L p =0.002). None of the study patients, but six patients in the control group required transfusion of blood products (p =0.02). No differences were recorded in postoperative antithrombin activity, bleeding, and other clinical outcomes. Conclusion: The HMS system, by facilitating maintenance of a stable heparin concentration, and by determining an appropriate dose of protamine, is associated with reduced platelet consumption and does not increase AT-III consumption and postoperative bleeding.


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