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Blood transfusion requirements in coronary artery surgery with and without the activated clotting time (ACT)
Insights
Automated control of anticoagulation using activated whole blood clotting time (ACT) significantly reduced blood transfusions and surgical time during coronary artery bypass grafting. This method optimized heparin and protamine use, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Anticoagulation management during cardiopulmonary bypass (CPB) is critical for patient safety.
- Standard fixed-dose protocols for heparin and protamine may lead to suboptimal outcomes.
- Automated monitoring of anticoagulation can potentially improve perioperative management.
Purpose of the Study:
- To evaluate the efficacy of automated activated whole blood clotting time (ACT) monitoring for anticoagulation control during CPB.
- To assess the impact of a computerized ACT dose-response method on heparin reversal and transfusion requirements.
- To compare surgical time and protamine doses between patients managed with automated ACT and standard protocols.
Main Methods:
- A prospective study comparing 150 patients undergoing coronary artery bypass grafting (CABG) using automated ACT monitoring (ACT group).
- A control group of 200 patients managed with a standard fixed-dose heparin and protamine protocol.
- Computerized ACT dose-response curves were used for heparin reversal in the ACT group.
Main Results:
- The ACT group showed significant reductions in whole blood (1,397 vs. 1,938 ml) and red blood cell (695 vs. 853 ml) transfusions.
- Protamine doses were lower in the ACT group (26.2 vs. 33.9 ml), while heparin doses were higher (31,440 vs. 26,760 IU).
- Surgical time was reduced in the ACT group (289 vs. 321 min).
Conclusions:
- Automated ACT monitoring and computerized heparin reversal significantly decrease blood transfusion needs in CABG patients.
- This approach also leads to reduced surgical duration and protamine administration.
- The findings support the use of automated ACT for optimized anticoagulation management during CPB.
Abstract:
Control of anticoagulation during cardiopulmonary bypass (CPB) with the automated activated whole blood clotting time (ACT) and reversal of heparin after CPB using a computerized ACT dose-response curve method resulted in significant reductions of blood transfusion requirements, surgical time, and protamine doses in 150 patients undergoing coronary artery bypass grafting procedures (ACT group) as compared to 200 patients for whom a standard fixed dose protocol for heparin and protamine was used (control patients). Mean transfusion requirements were 1,938 +/- 60 SEM ml whole blood and 853 +/- 48.3 SEM ml red blood cells for control patients and 1,397 +/- 59 SEM ml whole blood (P less than 0.001) and 695 +/- 34 SEM ml red blood cells (P less than 0.01) in the ACT group. ACT group patients also required less protamine with 26.2 +/- 0.60 SEM ml Protamine 1,000 (Roche) as compared to 33.9 +/- 0.49 SEM ml for control patients (P less than 0.001) but more heparin with 31,440 +/- 783 SEM I.U. versus 26,760 +/- 263 SEM I.U. (P less than 0.001). Surgical time decreased from 321 +/- 5.5 SEM min for control patients to 289 +/- 5.4 SEM min for ACT group patients (P less than 0.001).