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.

Temperature Effect on Coagulation Function in Mild Hypothermic Patients Undergoing Thoracic Surgeries: Thromboelastography (TEG) Versus Standard Tests

December 4, 2024 No Comments

This study compared coagulation monitoring methods in mild hypothermic patients during thoracic surgery. Thromboelastography (TEG) detected significant coagulation impairments, including delayed clot formation and reduced clot strength, which standard tests failed to reveal. Temperature-adjusted TEG showed worse coagulation function at core hypothermic temperatures. Findings suggest TEG’s superiority for hemostatic monitoring and transfusion guidance in hypothermic surgical patients.

Efficacy of Goal-Directed Versus Preemptive Tranexamic Acid Administration in Cardiovascular Surgery: The GDT Trial

December 4, 2024 No Comments

The GDT trial compares goal-directed tranexamic acid (TXA) administration guided by rotational thromboelastometry (ROTEM) to preemptive TXA administration in cardiovascular surgery. This multi-center, double-blind, randomized trial aims to determine non-inferiority in reducing postoperative bleeding. Secondary outcomes include transfusion rates, thromboembolic complications, seizures, and hospital costs. The study hypothesizes that selective TXA administration will lower adverse events compared to preemptive dosing.

Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Pediatric ECMO

November 28, 2024 No Comments

This pilot randomized controlled trial compared bivalirudin and unfractionated heparin for anticoagulation in 30 pediatric ECMO patients. No difference was found in time at goal anticoagulation, the primary endpoint. However, bivalirudin was associated with higher thrombotic complications (37.5% vs. 0%; p=0.02) but required fewer RBC transfusions (median 6.3 vs. 12.2 mL/kg/day; p=0.02). The study demonstrates feasibility for larger trials to evaluate the safety and efficacy of bivalirudin in pediatric ECMO.

Platelet Function Is Preserved After Moderate Cardiopulmonary Bypass Times But Transiently Impaired After Protamine

October 4, 2024 No Comments

This study assessed platelet function and numbers in 39 patients undergoing coronary artery bypass surgery with cardiopulmonary bypass (CPB). Platelet function was measured at six different points, including after protamine administration. Results showed no significant impairment of platelet function during CPB. However, platelet function was temporarily reduced after protamine but recovered within 3 hours post-surgery.