Key result
Heparin dose response tests consistently underestimate individualized bolus doses, linked to high baseline ACT.
Why the study?
Measured ACT following individualized heparin bolus calculated by heparin dose response testing often shows significant positive and negative errors from expected ACT during cardiopulmonary bypass.
What factors are associated with errors in the heparin dose response test for individualized heparin management during cardiopulmonary bypass?
Observational (n=250)
What factors are associated with errors in the heparin dose response test for individualized heparin management during cardiopulmonary bypass?
The accuracy of the heparin dose response test for cardiopulmonary bypass depends on baseline ACT, slope, and calculated heparin concentration, often leading to underestimation of required heparin.
Potential underestimation may risk subtherapeutic anticoagulation during bypass; leaves open whether baseline ACT adjustments improve outcomes in prospective trials.
BACKGROUND: A critical aspect of cardiopulmonary bypass (CPB) is to achieve full anticoagulation to prevent thrombosis and consumptive coagulation without using excessive amount of heparin. This can be achieved with heparin dose response (HDR) test in vitro to calculate an individualized heparin bolus to reach a target activated clotting time (ACT) and heparin concentration. However, we often observe that the measured ACT (mACT) with the calculated heparin bolus gives significant errors, both positive (mACT is higher than expected) and negative (mACT is lower), from expected ACT (eACT). METHODS: We performed a retrospective study of 250 patients who underwent cardiac surgery to attain an error distribution of the mACT from eACT with calculated heparin bolus. In addition, it is aimed to identify possible patterns of baseline ACT (bACT), calculated heparin concentration (CHC) and HDR slope that are associated with the significant positive and negative errors. RESULTS: We found that individualized heparin bolus by HDR test is consistently underestimated while it gave a significant number of positive and negative errors. Further analysis indicates that significant negative errors correlate with high bACT and slope and low CHC while significant positive errors with low bACT and slope and high CHC. CONCLUSION: The mACT can be substantially different from eACT. The accuracy of the HDR test appears to be dependent upon bACT, slope, and CHC. Based on our analysis, we provide several recommendations and a flow chart to improve the quality of individualized heparin management on CPB.
No takes yet. Share an insight, caveat, or question.
Lee et al. (2020) conducted an observational in Cardiac surgery requiring cardiopulmonary bypass (n=250). Heparin dose response (HDR) test was evaluated on Error distribution of the measured ACT from expected ACT with calculated heparin bolus. Individualized heparin bolus by the heparin dose response test is consistently underestimated, with negative errors correlating with high baseline ACT and low calculated heparin concentration.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: