Key result
A newly developed formula incorporating baseline ACT and body weight for initial heparin dosing achieved the target ACT >400 seconds in 86.4% of patients undergoing cardiac surgery.
Why the study?
Does a new heparin dosing formula incorporating baseline ACT and body weight achieve target ACT >400 seconds in patients undergoing cardiopulmonary bypass?
Observational (n=141)
No
Does a new heparin dosing formula incorporating baseline ACT and body weight achieve target ACT >400 seconds in patients undergoing cardiopulmonary bypass?
A novel heparin dosing formula incorporating baseline ACT and body weight successfully achieved target ACT for safe initiation of cardiopulmonary bypass in 86.4% of patients.
Answers are grounded in this paper and cite their sources.
May support individualized heparin dosing to reach target ACT; hypothesis-generating and requires randomized trials before practice change.
Introduction: Anticoagulation is essential during CPB in cardiac surgery. It is generally performed using heparin; however the widely used formula for its dosing is based solely on body weight. Although the formula assumes activated clotting time (ACT) to be within normal range, baseline ACT varies in each patient. Thus, we developed an original formula, which takes into account baseline ACT in addition to body weight to calculate a more proper dose for initial administration of heparin. In this study, we monitored the ACT to examine if the dose of heparin calculated using our formula can prolong the ACT to the target range, and we determined the factors which interfere with the prolongation of ACT. Methods: Between October 2010 and April 2011, 141 consecutive patients underwent cardiac surgery requiring cardiopulmonary bypass at our hospital. We measured ACT 3 minutes after the initial administration of heparin and considered ACT values >400 seconds as appropriate for safe initiation of CPB. Results: Using the proposed formula, administered heparin dose was 241 ± 27 IU/kg and target ACT was achieved in 86.4% of patients. Multivariate analysis was performed to determine the effect of patient background factors on target ACT achievement. Body weight, age, and preoperative heparin therapy, which showed significant differences, were further analyzed. Conclusions: This study demonstrated that our newly developed formula could be used to properly calculate the optimal initial dose of heparin.
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Nakasuji et al. (2014) conducted an observational in Cardiac surgery requiring cardiopulmonary bypass (n=141). New formula for calculating heparin dose was evaluated on Target ACT >400 seconds 3 minutes after initial administration. A newly developed formula incorporating baseline ACT and body weight for initial heparin dosing achieved the target ACT >400 seconds in 86.4% of patients undergoing cardiac surgery.
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