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Baseline activated coagulation time should be measured after surgical incision
G P Gravlee1, C L Whitaker, L J Mark
1Department of Anesthesia, Wake Forest University Medical Center, Winston-Salem, North Carolina 27103.
Anesthesia and Analgesia
|November 1, 1990
Summary
Baseline activated coagulation time (ACT) decreases with anesthesia and surgery. Measuring ACT after sternotomy provides the most accurate baseline for assessing heparin neutralization post-cardiac surgery.
Area of Science:
- Anesthesiology
- Cardiovascular Surgery
- Hematology
Background:
- Activated coagulation time (ACT) is crucial for guiding heparin and protamine dosing in cardiac surgery.
- Current protocols often use pre-procedure ACT as a baseline, but results comparing baseline to post-protamine ACT are inconsistent.
Purpose of the Study:
- To investigate the optimal timing for establishing a baseline ACT measurement.
- To determine if baseline ACT measurements are affected by anesthetic induction and surgical procedures.
Main Methods:
- ACT measurements were taken at three intervals: before anesthesia, after anesthesia, and after sternotomy.
- The study included 68 patients undergoing cardiac surgery at two institutions.
- Post-protamine ACT values were compared to each baseline ACT measurement.
Main Results:
- Baseline ACT significantly decreased after anesthetic induction and sternotomy.
- The ACT measured after sternotomy most closely correlated with the post-protamine ACT.
- Pre-anesthetic induction ACT measurements may lead to inaccurate assessments of heparin neutralization.
Conclusions:
- Surgical procedures appear to induce a thromboplastic response that lowers ACT.
- Establishing baseline ACT after surgical incision, specifically sternotomy, is recommended.
- This timing ensures more accurate assessment of heparin neutralization adequacy following cardiopulmonary bypass.