Heparin Anticoagulation Management During Cardiopulmonary Bypass

Contemporary Clinical Practices in Anticoagulation Management During Cardiopulmonary Bypass: A Europe-Wide Survey

March 10, 2026 No Comments

A Europe-wide survey of 114 cardiac surgery centers across 29 countries evaluated current anticoagulation practices during cardiopulmonary bypass. Most centers reported standardized heparin protocols and commonly used a 300 IU/kg initial dose with ACT targets of 400–480 seconds. However, substantial variability existed in protamine reversal strategies, post-reversal ACT targets, and transfusion decision-making, highlighting gaps between guidelines and real-world practice. These findings identify key opportunities for standardizing perioperative anticoagulation management in cardiac surgery.

The Impact of Intraoperative Fibrinogen Replacement Therapy on the Clinical Outcome of Surgical Therapy for Type A Acute Aortic Dissection

March 6, 2026 No Comments

This retrospective study evaluated the role of fibrinogen replacement therapy (FRT) using fibrinogen concentrate during emergency surgery for acute type A aortic dissection (ATAAD). Among 87 patients, FRT significantly improved postoperative fibrinogen levels and helped maintain hemostasis without increasing complications. Although intraoperative blood loss was higher in the FRT group due to more severe coagulopathy, postoperative bleeding was similar between groups, suggesting FRT effectively stabilizes coagulation during complex aortic surgery.

Balancing Bleeding and Clotting: Anticoagulation Strategies During ECMO Support

Efficacy of Reduced-Intensity or No Heparin Versus Standard Heparin Anticoagulation in Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-AnalysiS

February 17, 2026 No Comments

This systematic review and meta-analysis of 11 studies (958 ECMO patients) compared reduced-intensity or no heparin anticoagulation with standard heparin strategies. Low/no heparin significantly reduced bleeding complications (OR 0.49) without increasing thrombotic events or in-hospital mortality. Transfusion requirements showed no significant difference. Findings support individualized anticoagulation strategies, though high-quality randomized trials remain needed.

Optimising Protamine Dosing for Heparin Reversal After Cardiopulmonary Bypass: A Population Pharmacokinetic—Pharmacodynamic Study

February 15, 2026 No Comments

This prospective study of 68 cardiac surgery patients used pharmacometric modeling to determine optimal protamine dosing for reversing unfractionated heparin after cardiopulmonary bypass. Researchers found that a protamine-to-heparin ratio of 0.625:1 achieved complete reversal in 95% of patients, lower than the commonly used 1:1 ratio. The study also revealed that activated clotting time (ACT) unreliably reflects residual heparin, suggesting fixed low-ratio dosing may be a practical alternative requiring validation.

An In-Vitro Study of the Timing Between Protamine Sulfate Administration and Cardiotomy Suction Termination

January 28, 2026 No Comments

This in-vitro study evaluates the optimal timing for discontinuing cardiotomy suction during cardiopulmonary bypass (CPB) when reversing heparin anticoagulation with protamine sulfate. Using porcine blood samples, the researchers assessed activated clotting times (ACTs) after administering a protamine test dose (PTD) and 1/3 of the full dose. Results showed significant ACT reductions after each stage, suggesting early suction termination is vital to preserve circuit integrity.

Protamine Test Dose: Impact on Activated Clotting Time and Circuit Integrity

March 8, 2025 No Comments

This study examines the effect of a protamine test dose (PTD) on activated clotting times (ACTs) and cardiopulmonary bypass (CPB) circuit integrity in 120 cardiac surgery patients. The study found that PTDs led to unpredictable and often significant reductions in ACT, increasing the risk of clot formation in the CPB circuit. The authors recommend discontinuing the recovery of mediastinal shed blood into the CPB circuit before protamine administration to enhance patient safety.

On-Pump FIBTEM-A5 Accurately Predicts the A5 Values After Protamine Administration

February 18, 2025 No Comments

This study investigates whether on-pump FIBTEM-A5 values measured during cardiopulmonary bypass (CPB) accurately predict post-protamine administration values. Conducted at a single cardiac center, the retrospective analysis of 70 patients found a strong correlation (R² = 0.813) between the two measurements. Despite a statistically significant but clinically negligible difference, the findings support using on-pump FIBTEM-A5 to guide fibrinogen supplementation in cardiac surgery.

Platelet Inhibitor Withdrawal and Outcomes After Coronary Artery Surgery: An Individual Patient Data Meta-Analysis

February 3, 2025 No Comments

This study analyzes the impact of preoperative withdrawal of P2Y12 receptor inhibitors on bleeding and ischemic outcomes in coronary artery bypass grafting (CABG). Using individual patient data from 4,837 patients across seven observational studies, the meta-analysis finds that guideline-conforming withdrawal reduces severe bleeding (BARC-4) risk by 50% without increasing mortality or postoperative ischemic events. These findings support adherence to standardized preoperative withdrawal guidelines.

Anticoagulation Monitoring During ECMO Support: Monitor or Flip a Coin?

December 20, 2024 No Comments

This editorial reviews the complexities of anticoagulation monitoring during extracorporeal membrane oxygenation (ECMO), emphasizing the balance between preventing thromboembolic events and minimizing hemorrhagic risks. Current tools like ACT, aPTT, and anti-factor Xa assays are evaluated for their efficacy and limitations. While aPTT remains widely used, anti-factor Xa is emerging as a promising alternative. The authors call for more research and advanced monitoring strategies to improve clinical outcomes.

Anticoagulation Management for Veno-Venous ECMO in COVID-19 Patients: Argatroban as Rescue Therapy in Heparin-Associated Thrombocytopenia

December 7, 2024 No Comments

This study examines the use of argatroban as an alternative to unfractionated heparin (UFH) for anticoagulation during veno-venous ECMO in COVID-19 patients with heparin-associated thrombocytopenia (HIT). Data from 40 patients revealed a lower incidence of bleeding with argatroban compared to UFH, particularly at tracheal stoma sites. Platelet counts showed better preservation with argatroban, despite comparable efficacy in preventing thrombotic events. Argatroban offers a safer alternative for HIT cases in ECMO.