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.

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.

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.

Protamine Dosing for Heparin Reversal After Cardiopulmonary Bypass: A Double-Blinded Prospective Randomized Control Trial Comparing Two StrategieS

November 24, 2024 No Comments

This study compared two protamine dosing strategies for heparin reversal after cardiopulmonary bypass: a fixed 250-mg dose versus a 1:1 (1 mg:100 U heparin) ratio-based approach. The trial included 125 elective adult cardiac surgery patients. Both methods showed similar activated clotting times and postoperative bleeding, but the fixed-dose group used significantly less protamine. These results suggest fixed dosing may optimize drug conservation without compromising safety or efficacy.

Thromboembolic Complications in Continuous Versus Interrupted Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Study

September 28, 2024 No Comments

This study investigates thromboembolic complications in patients undergoing venovenous extracorporeal membrane oxygenation (ECMO) with continuous versus interrupted anticoagulation. Data from 346 patients across three ECMO centers were analyzed. Results showed no significant difference in thrombotic complications between the groups, although interruptions in anticoagulation were linked to increased thrombotic events as the frequency and duration of interruptions rose.

Cardiopulmonary Bypass in a Pediatric Patient with Factor XII Deficiency

September 21, 2024 No Comments

This case report discusses the challenges of managing cardiopulmonary bypass (CPB) in an 8-month-old pediatric patient with factor XII deficiency, a rare coagulopathy that complicates anticoagulation monitoring. The use of the Hemochron Signature Elite with ACT+ cartridges provided reliable anticoagulation monitoring during surgery. The report reviews current strategies for managing CPB in patients with this condition, highlighting the importance of specialized tools for predictable results.

Heparin Resistance Management During Cardiac Surgery: A Literature Review and Future Directions

September 21, 2024 No Comments

This article reviews the complexities of heparin resistance (HR) during cardiac surgery, highlighting its causes, diagnosis, and management strategies. HR, characterized by insufficient response to heparin, can result in serious surgical complications. The authors discuss diagnostic methods like assessing activated clotting time (ACT) and propose management strategies such as heparin dosage adjustments, antithrombin supplementation, and alternative anticoagulants to improve patient outcomes.

Activated Clotting Time Value as an Independent Predictor of Postoperative Bleeding and Transfusion

May 8, 2024 No Comments

This study examines the incidence and predictors of bleeding and thrombosis in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) after out-of-hospital cardiac arrest due to ventricular tachycardia/fibrillation. Among 200 patients, 67.5% experienced major bleeding, primarily from CPR-related trauma. Decreased fibrinogen levels were linked to bleeding, but bleeding did not significantly affect in-hospital mortality. Thrombosis occurred in 23.5% of patients and was not associated with in-hospital death.

Social:

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

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

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

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

Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Pediatric ECMO

Protamine Dosing for Heparin Reversal After Cardiopulmonary Bypass: A Double-Blinded Prospective Randomized Control Trial Comparing Two StrategieS

Thromboembolic Complications in Continuous Versus Interrupted Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Study

Cardiopulmonary Bypass in a Pediatric Patient with Factor XII Deficiency

Heparin Resistance Management During Cardiac Surgery: A Literature Review and Future Directions

Activated Clotting Time Value as an Independent Predictor of Postoperative Bleeding and Transfusion

Help Mend a Heart!

Learn More

Action

Contact

Follow us

© 2025 International Perfusion Association