The impact of heparin concentration and activated clotting time monitoring on blood conservation. A prospective, randomized evaluation in patients undergoing cardiac operation

G. J. Despotis, J. H. Joist, C. W. Hogue, A. Alsoufiev, K. Kater, L. T. Goodnough, S. A. Santoro, E. Spitznagel, M. Rosenblum, D. G. Lappas

Research output: Contribution to journalArticle

Abstract

A whole blood hemostasis system (Hepcon) provides both activated clotting time and accurate whole blood heparin concentration measurements via an automated protamine titration method. This study was designed to prospectively evaluate the impact of heparin and protamine administration using this system on the incidence and treatment of bleeding after cardiopulmonary bypass. Two hundred fifty-four patients requiring cardiopulmonary bypass were enrolled in this prospective study over a 7-month period. Patients treated with antifibrinolytic agents (aprotinin, ε-aminocaproic or tranexamic acid) were excluded. Patients were randomly assigned to either a control (n=127) or intervention (n=127) group. For control patients, the anticoagulation protocol consisted of an initial fixed dose of 250 U/kg of heparin, and additional 5000 U heparin doses were administered if the activated clotting time was less than 480 seconds. Heparin was neutralized with an initial fixed dose of protamine (0.8 mg protamine per milligram total heparin). For the intervention group, an initial dose of heparin was based on an automated heparin dose-response assay. Additional heparin doses were administered if the heparin concentration was less than the reference concentration or for an activated clotting time less than 480 seconds. The protamine dose was based on the residual heparin concentration. Treatment of excessive bleeding after cardiopulmonary bypass was based on an algorithm using point-of-care testing with whole blood prothrombin time, activated partial thromboplastin time, heparinase activated clotting time, and platelet count. No differences between the two treatment groups were identified in reference to demographic factors, preoperative anticoagulant medications, preoperative coagulation data, number of reoperations, or combined procedures and duration of cardiopulmonary bypass. Indirect evidence for coagulation factor consumption was demonstrated in control patients by more prolonged whole blood prothrombin time and activated partial thromboplastin time values after cardiopulmonary bypass when compared with values obtained in the intervention group. Patients in the intervention cohort received greater doses of heparin (intervention: 612±147, control: 462±114 U/kg, p

Original languageEnglish (US)
Pages (from-to)46-54
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume110
Issue number1
DOIs
StatePublished - 1995
Externally publishedYes

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Heparin
Protamines
Cardiopulmonary Bypass
Partial Thromboplastin Time
Prothrombin Time
Heparin Lyase
Hemorrhage
Tranexamic Acid
Antifibrinolytic Agents
Aprotinin
Blood Coagulation Factors
Hemostasis
Platelet Count
Reoperation
Anticoagulants
Therapeutics
Demography
Prospective Studies
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

The impact of heparin concentration and activated clotting time monitoring on blood conservation. A prospective, randomized evaluation in patients undergoing cardiac operation. / Despotis, G. J.; Joist, J. H.; Hogue, C. W.; Alsoufiev, A.; Kater, K.; Goodnough, L. T.; Santoro, S. A.; Spitznagel, E.; Rosenblum, M.; Lappas, D. G.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 110, No. 1, 1995, p. 46-54.

Research output: Contribution to journalArticle

Despotis, G. J. ; Joist, J. H. ; Hogue, C. W. ; Alsoufiev, A. ; Kater, K. ; Goodnough, L. T. ; Santoro, S. A. ; Spitznagel, E. ; Rosenblum, M. ; Lappas, D. G. / The impact of heparin concentration and activated clotting time monitoring on blood conservation. A prospective, randomized evaluation in patients undergoing cardiac operation. In: Journal of Thoracic and Cardiovascular Surgery. 1995 ; Vol. 110, No. 1. pp. 46-54.
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AU - Joist, J. H.

AU - Hogue, C. W.

AU - Alsoufiev, A.

AU - Kater, K.

AU - Goodnough, L. T.

AU - Santoro, S. A.

AU - Spitznagel, E.

AU - Rosenblum, M.

AU - Lappas, D. G.

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