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Related Concept Videos

Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

686
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
686

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Updated: Jun 26, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Activated clotting time-guided heparinization during open AAA surgery: a pilot study.

Liliane C Roosendaal1,2,3, Max Hoebink1,2,3, Arno M Wiersema1,2,3

  • 1Department of Vascular Surgery, Dijklander Ziekenhuis, Maelsonstraat 3, 1624 NP, Hoorn, The Netherlands.

Pilot and Feasibility Studies
|May 9, 2024
PubMed
Summary

This pilot study shows activated clotting time (ACT)-guided heparinization is feasible for preventing arterial thrombo-embolic complications (TEC) during open abdominal aortic aneurysm (AAA) surgery. Further trials are needed to confirm if this method improves patient outcomes compared to standard heparin dosing.

Keywords:
Activated clotting timeAneurysmHeparinNon-cardiac arterial procedures

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Area of Science:

  • Vascular Surgery
  • Anesthesiology
  • Cardiovascular Research

Background:

  • Arterial thrombo-embolic complications (TEC) remain a significant risk during non-cardiac arterial procedures (NCAP).
  • Current unfractionated heparin protocols for TEC prevention lack standardized dosing strategies.
  • This study addresses the need for optimized heparinization in open abdominal aortic aneurysm (AAA) surgery.

Purpose of the Study:

  • To evaluate the effectiveness and feasibility of an activated clotting time (ACT)-guided heparinization protocol.
  • To compare ACT-guided heparinization with a standard 5000 IU heparin bolus in open AAA repair.
  • To establish a basis for future randomized controlled trials (RCTs) on heparin dosing strategies.

Main Methods:

  • A prospective, multicentre pilot study included patients undergoing elective open AAA repair.
  • Two groups were compared: ACT-guided heparinization (100 IU/kg initial dose) versus a single 5000 IU heparin bolus.
  • Primary outcome was the feasibility and effectiveness of the ACT-guided protocol; safety outcomes included bleeding, TEC, and mortality.

Main Results:

  • All 32 patients on the ACT-guided protocol achieved the target ACT (>200 s).
  • Thrombo-embolic complications (TEC) occurred in 9.4% of the ACT-guided group versus 17% in the standard group.
  • Bleeding complications were similar (28% vs. 33%), with no mortality in either group.

Conclusions:

  • ACT-guided heparinization with 100 IU/kg is feasible and achieves adequate anticoagulation during open AAA surgery.
  • The protocol demonstrates potential for managing anticoagulation effectively.
  • Further randomized studies are warranted to confirm clinical benefits and optimize heparin dosing for improved patient outcomes.