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Perfusion
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Measurement of the activated clotting time during cardiopulmonary bypass: differences between Hemotec® ACT and Hemochron® Jr apparatus

S Svenmarker

Department of Surgical and Perioperative Science, University Hospital of Umeå, Umeå, Sweden, staffan.svenmarker.us{at}vll.se

M Appelblad

Department of Surgical and Perioperative Science, University Hospital of Umeå, Umeå, Sweden

E Jansson

Department of Surgical and Perioperative Science, University Hospital of Umeå, Umeå, Sweden

S Häggmark

Department of Surgical and Perioperative Science, University Hospital of Umeå, Umeå, Sweden

Background: Measurement of the activated clotting time (ACT) represents a standard method for coagulatory assessments. The test employs specific agents to trigger the coagulation process. The present study aimed to compare kaolin (Hemotec®) versus a combination of silica, kaolin and phospholipid (Hemochron® Jr) ACTs.

Methods: Hemotec® and Hemochron® Jr ACT monitors were compared by simultaneous measurement of paired arterial blood samples (n-114) with respect to precision and bias during clinical conditions of cardio-pulmonary bypass (CPB). The influence of haemodilution on the ACT was tested in an ex-vivo model.

Results: The precision of Hemotec® and Hemochron®Jr ACT measurements attained 21±2.6 s versus 27.0±2.6 s(p= 0.126) during CPB and 2.5±2.2 s versus 9.4±6.9 s (p= 0.000) after protamine administration, respectively. The Hemochron® Jr monitor was associated with a bias of –102±13.7 s compared to the Hemotec® ACT monitor (p= 0.000) during CPB and –6.9±2.9 s after protamine (p= 0.025). Linear regression analysis of ACT readings between monitors reached r- 0.526 (p= 0.000). Hemochron® Jr ACT values correlated with the erythrocyte volume fraction r- 0.379 (p= 0.000). Ex-vivo data indicated that the Hemotec® ACT monitor was associated with relatively higher ACT readings after haemodilution.

Conclusion: The ACT is not a standardized measure. Test results are strongly associated with the specific compounds used to initiate the coagulation process.

Perfusion, Vol. 19, No. 5, 289-294 (2004)
DOI: 10.1191/0267659104pf755oa
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