Key result
Stepwise lean body weight-based heparin dosing achieves target ACT in ~99% of on-pump cardiac surgeries.
Why the study?
Weight-based unfractionated heparin dosing before CPB may overestimate requirements in patients with lesser lean body weight.
Does lean body weight-based unfractionated heparin dosing achieve adequate anticoagulation in adults undergoing elective on-pump cardiac surgery?
Cohort (n=81)
No
Does lean body weight-based unfractionated heparin dosing achieve adequate anticoagulation in adults undergoing elective on-pump cardiac surgery?
A lean body weight-based, stepwise unfractionated heparin dosing protocol is feasible and achieves target activated clotting time before cardiopulmonary bypass in almost all adult patients.
Answers are grounded in this paper and cite their sources.
Supports feasibility of lean body weight-based heparin dosing in on-pump surgery; hypothesis-generating pending randomized validation.
Objectives: Weight-based unfractionated heparin (UFH) dosing before cardiopulmonary bypass (CPB) may overestimate requirements in patients with lesser lean body weight. We evaluated the feasibility of lean body weight (LBW)-based heparin dosing to achieve a target activated clotting time (ACT) before CPB in Indian adults undergoing elective on-pump cardiac surgery. Material and Methods: In this single-centre prospective observational study, 81 adults aged 18–70 years undergoing elective on-pump cardiac surgery received intravenous heparin 300 IU/kg LBW. ACT was measured 3 minutes later. Patients with ACT <480 s received protocol-guided escalation to 350 and then 400 IU/kg LBW. Patients who remained below target after 400 IU/kg LBW received 400 IU/kg actual body weight (ABW). Results: After 300 IU/kg LBW, 63/81 patients (77.8%; 95% confidence interval [CI], 68.8–86.8) achieved an ACT ≥480 s. A further 15 (18.5%; 95% CI, 10.0–27.0) achieved target ACT after 350 IU/kg LBW, and 2 (2.5%; 95% CI, 0.3–8.7) after 400 IU/kg LBW. One patient (1.2%; 95% CI, 0.03–6.7) required 400 IU/kg ABW. Thus, 80/81 patients (98.8%) achieved target ACT using the LBW-based escalation protocol. No participant met the study definition of heparin resistance. Conclusion: A LBW-based, stepwise heparin protocol achieved target ACT before CPB in almost all participants and was feasible in this cohort. Comparative studies incorporating heparin concentration monitoring and clinical bleeding outcomes are needed before routine adoption.
No takes yet. Share an insight, caveat, or question.
Joshi et al. (2026) conducted a cohort in Elective on-pump cardiac surgery (n=81). Lean body weight-based unfractionated heparin was evaluated on Achievement of target activated clotting time (ACT) ≥480 s using LBW-based escalation protocol. A lean body weight-based stepwise unfractionated heparin dosing protocol successfully achieved the target activated clotting time of ≥480 seconds in 98.8% of adult patients undergoing on-pump cardiac surgery.
Synapse has enriched 10 related papers. Consider them for comparative context: