Key result
Measuring baseline activated coagulation time after sternotomy best matched postprotamine ACT, as anesthesia and surgery significantly decreased baseline ACT.
Why the study?
Does measuring baseline ACT after sternotomy compared to before induction improve the match with postprotamine ACT in cardiac surgery patients?
Observational (n=68)
Yes
Does measuring baseline ACT after sternotomy compared to before induction improve the match with postprotamine ACT in cardiac surgery patients?
Measuring baseline ACT after surgical incision rather than before induction provides a more accurate target for assessing heparin neutralization after cardiopulmonary bypass.
Post-sternotomy baseline ACT timing may better inform heparin reversal assessment; extends ACT variability observations but leaves open effects on outcomes.
The activated coagulation time (ACT) is widely used to guide heparin and protamine dosing during cardiac surgery. A common protocol involves establishing a baseline ACT before administering heparin, then using this ACT as a target value for assessing the adequacy of heparin neutralization after cardiopulmonary bypass. Results vary in previous comparisons of baseline ACT to postprotamine ACT, with some showing postprotamine ACT significantly below baseline values. The present study examined ACTs at three possible baseline intervals in 68 patients at two institutions: (a) before anesthetic induction; (b) after anesthetic induction; and (c) after sternotomy. Baseline ACT decreased significantly with anesthesia and surgery. The poststernotomy baseline ACT best matched the postprotamine ACT. It appears likely that surgery induces a thromboplastic response that decreases ACT. Establishing baseline ACT before anesthetic induction would predispose to false diagnoses of adequate protamine neutralization after cardiopulmonary bypass, because ACT is relatively insensitive to low concentrations of unneutralized heparin. Baseline ACTs should therefore be measured after surgical incision.
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Gravlee et al. (1990) conducted an observational in Cardiac surgery (n=68). Poststernotomy baseline ACT measurement vs. Pre-induction or post-induction baseline ACT measurement was evaluated on Match between baseline ACT and postprotamine ACT. Measuring baseline activated coagulation time after sternotomy best matched postprotamine ACT, as anesthesia and surgery significantly decreased baseline ACT.
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