International Perfusion Association


Category: Heparin

ACT 480

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

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.


Antithrombotic Drug Removal with Hemoadsorption During Off-Pump Coronary Artery Bypass Grafting

This study evaluates the efficacy of using a hemoadsorption cartridge to remove antithrombotic drugs during off-pump coronary artery bypass grafting (OPCAB). Ten patients, predominantly male and with a mean age of 67.4 years, were treated with antithrombotics like ticagrelor and rivaroxaban. Hemoadsorption was integrated into the perioperative management using either a dialysis device or a standalone apheresis pump, showing a mean treatment time of 145 minutes. Results indicated low rates of bleeding, no deaths, or further interventions during a mean follow-up of 19.5 months, demonstrating that this method is feasible and safe.


Contributing Factors to Heparin Resistance During Cardiopulmonary Bypass

This study delves into heparin resistance (HR) during cardiopulmonary bypass (CPB) surgeries, analyzing 371 patients to identify contributing factors. HR, defined as the inability to achieve an activated clotting time of >480 seconds with an initial unfractionated heparin dose, was observed in 9.7% of cases. Key findings include the significant association of preoperative use of unfractionated heparin, certain blood parameters (e.g., white blood cell counts, fibrinogen levels), and notably, albumin and fibrinogen as independent predictors for HR. The research highlights the need for precise preoperative assessments to mitigate HR risks in CPB.

Blood Hemolysis

Finding a Common Definition of Heparin Resistance in Adult Cardiac Surgery: Communication from the ISTH SSC Subcommittee on Perioperative and Critical Care Thrombosis and Hemostasis

Ensuring sufficient anticoagulation in cardiac surgery and cardiopulmonary bypass is crucial for preventing adverse outcomes. This review evaluates various definitions of heparin resistance in this context, proposing a standardized definition based on the inability to achieve an activated clotting time target of 480 or more after a dose of 500 U/kg of heparin.


Protamine Dose to Neutralize Heparin at the Completion of Cardiopulmonary Bypass Can be Reduced Significantly Without Affecting Post-Operative Bleeding

The study investigated reducing the protamine-to-heparin ratio (P-to-H) from 1:1 to 0.9:1 and 0.8:1 in cardiac surgery patients to determine its effect on post-operative bleeding. Results showed a significant reduction in the actual protamine dose without an increase in post-op bleeding, suggesting that a ratio as low as 0.75:1 might be sufficient for effective neutralization of heparin.


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