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

Pappalardo Federico

Franco Annalisa

Crescenzi Giuseppe

Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Hospital, Milan, Italy

De Simone Francesco

Unit of Extracorporeal Circulation, San Raffaele Hospital, Milan, Italy

Torracca Lucia

Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy

Zangrillo Alberto

Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Hospital, Milan, Italy

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± 45x109/L versus 125±27 x 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: he 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.

Perfusion, Vol. 21, No. 5, 285-290 (2006)
DOI: 10.1177/0267659106074770
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