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[New screening method for coagulation abnormality including AT III deficiency during CABG]
K Nakamura1, T Hata, Y Tsushima
1Department of Cardiovascular Surgery, Cardiac Center Sakakibara Hospital, Okayama, Japan.
Insights
Activated Clotting Time (ACT) testing after 1 ml heparin administration can screen for coagulation abnormalities, including Antithrombin III deficiency, during Coronary Artery Bypass Grafting (CABG) surgery. This simple method aids in preventing adverse events in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Context:
- Patients undergoing Coronary Artery Bypass Grafting (CABG) often receive heparin to prevent thrombosis.
- Coagulation abnormalities, such as Antithrombin III (AT III) deficiency, can complicate CABG procedures.
- Standard heparin protocols may not adequately identify all patients at risk for bleeding or clotting complications.
Purpose:
- To evaluate the utility of Activated Clotting Time (ACT) testing as a screening tool for coagulation abnormalities.
- To determine if ACT measurement before and after a standard heparin dose can identify patients with AT III deficiency.
- To establish a simple, convenient method for assessing coagulation status during CABG.
Summary:
- A study involving 100 patients undergoing CABG assessed ACT before (c-ACT) and after (h-ACT) 1 ml heparin administration.
- ACT extension (c-ACT - h-ACT) was calculated; a value less than 30 seconds indicated potential issues.
- Two of three patients with ACT extension < 30 seconds had AT III deficiency, suggesting ACT's screening capability.
Impact:
- This study introduces a novel, straightforward screening method for identifying coagulation disorders during CABG.
- Early detection of abnormalities like AT III deficiency can lead to timely interventions, potentially improving patient outcomes.
- The ACT test provides a practical approach to enhance patient safety in cardiac surgery settings.
Abstract:
In our institute, 1 ml of heparin is administered to the patients undergoing CABG before dissection and mobilization of the internal thoracic arteries (ITAs) and/or right gastroepiploic artery (GEA) to prevent possible thrombosis or coagulation tendency. Two patients with AT III deficiency underwent CABG and one of them died. The aim of this study is to know whether ACT check before and after administration of 1 ml of heparin is useful as a screening test of coagulation abnormalities including AT III deficiency. One hundred patients (84 males and 16 females) undergoing CABG were studied. Age ranged from 41 to 79 years (mean 64.8 +/- 8.0 years). One ml of heparin was administered to all the patients before ITAs and/or GEA were dissected and mobilized. ACT was doubly checked before (control ACT: c-ACT) and after (heparinized ACT: h-ACT) administration of heparin. ACT extension was defined as follows: ACT extension = (c-ACT)-(h-ACT). Mean c-ACT was 124 +/- 12 sec., h-ACT 188 +/- 26 sec. and ACT extension 64 +/- 24 sec. There were only 3 cases which ACT extension were less than 30 sec.: two of them were combined with AT III deficiency and the other was due to insufficient administration of heparin. In conclusion, examination of ACT after 1 ml administration of heparin is new, simple and convenient screening method for coagulation abnormalities including AT III deficiency during CABG.