STS/SCA/AmSECT Clinical Practice Guidelines: Anticoagulation during Cardiopulmonary Bypass

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Extracorporeal Technology

Background:

• Cardiopulmonary bypass (CPB) has been used for over 50 years with limited standardized guidelines for anticoagulation.
• Significant practice variability exists in heparin use, monitoring, reversal, and alternative anticoagulants during CPB.
• An Evidence Based Workgroup was formed by STS, SCA, and AmSECT to address these gaps.

Purpose of the Study:

• To develop a clinical practice guideline for anticoagulation during CPB.
• To standardize anticoagulation practices based on available evidence.
• To fill the evidence gap and establish best practices in CPB anticoagulation.

Main Methods:

• Systematic review of literature from January 2000 to December 2015, supplemented by pre-2000 sentinel publications.
• Literature searches conducted in PubMed using standardized MeSH terms.
• Interdisciplinary workgroup developed recommendations with >2/3 agreement, assessing evidence levels.

Main Results:

• Ninety-six manuscripts from 2000-2015 and 17 pre-2000 manuscripts were included in the final review.
• Recommendations cover heparin dosing/monitoring, contraindications/alternatives, and anticoagulation reversal.
• Evidence levels were assessed using AHA/ACCF Task Force guidelines.

Conclusions:

• The guideline aims to standardize anticoagulation practices for CPB.
• It serves as a resource for clinicians and encourages further research.
• Best practices for heparin management and alternatives during CPB are established.