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Related Concept Videos

Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

601
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...
601

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Related Experiment Video

Updated: May 29, 2025

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
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Low-Range Heparin and Protamine Detection: A Single-Center Prospective Diagnostic Study.

Michael Vandenheuvel1, Laura Vierstraete2, Filip De Somer3

  • 1Department of Anaesthesia, University Hospital Ghent, Ghent, Belgium.

Journal of Cardiothoracic and Vascular Anesthesia
|January 31, 2025
PubMed
Summary
This summary is machine-generated.

The Sonoclot slope-45 accurately detects low heparin levels, even with protamine present. This new parameter offers a sensitive and reliable method for monitoring heparin activity post-surgery.

Keywords:
blood coagulation testsheparinpoint-of-care testingprotamineviscoelastic testing

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Area of Science:

  • Anesthesiology and Critical Care Medicine
  • Hematology
  • Biomedical Engineering

Background:

  • Accurate detection of low-range heparin activity is crucial for managing heparin reversal and rebound, particularly after cardiopulmonary bypass.
  • Existing methods like anti-Xa activity (aXa), activated partial thromboplastin time (aPTT), kaolin-activated clotting time (kACT), and ROTEM viscoelastic tests have limitations in sensitivity, point-of-care availability, or cost.
  • The Sonoclot viscoelastic test offers a potential alternative for monitoring heparin activity.

Purpose of the Study:

  • To evaluate the performance of the Sonoclot slope-45 parameter for detecting low-dose heparin activity.
  • To assess the impact of protamine, alone and in combination with heparin, on various coagulation parameters, including the Sonoclot slope-45.
  • To compare the sensitivity of the Sonoclot slope-45 against established coagulation tests.

Main Methods:

  • A prospective in vitro study was conducted using blood samples from 10 healthy volunteers.
  • Blood samples were treated ex vivo with incremental low doses of heparin, protamine, or a combination of both.
  • The effects on anti-Xa activity (aXa), activated partial thromboplastin time (aPTT), iSTAT kaolin-activated clotting time (kACT), ROTEM clotting time ratio, and the Sonoclot slope-45 were analyzed using receiver operating curve analysis.

Main Results:

  • The Sonoclot slope-45, along with aXa and aPTT, reliably detected low heparin activity in spiked blood samples.
  • The iSTAT kACT was found to be insensitive to low heparin concentrations.
  • Protamine, whether administered alone or with heparin, did not significantly affect any of the tested coagulation parameters, including the Sonoclot slope-45.

Conclusions:

  • The Sonoclot slope-45 demonstrates high sensitivity for detecting low-dose heparin activity.
  • This sensitivity is maintained even in the presence of protamine, suggesting its utility in assessing heparin reversal.
  • The Sonoclot slope-45 was found to be insensitive to protamine alone, further clarifying its specific role in heparin monitoring.