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[Heparin level determination during extracorporeal circulation in open heart surgery]
Fortschritte Der Medizin
|December 8, 1983
Summary
Measuring heparin levels during extracorporeal circulation is now possible with synthetic substrates. This improves anticoagulant control when high heparin dosages are necessary, especially during open heart surgery.
Area of Science:
- Biochemistry
- Hematology
- Medical Technology
Context:
- Extracorporeal circulation requires high heparin dosages, complicating coagulation monitoring (thrombin time, aPTT).
- Accurate heparin level determination is crucial for patient safety during complex procedures like open-heart surgery.
- Existing methods are insufficient for precise measurement at high therapeutic heparin concentrations.
Purpose:
- To evaluate a novel method for measuring heparin and Antithrombin III (AT III) levels using synthetic substrates.
- To assess the feasibility of the "Protopath proteolytic enzyme detection system" for real-time heparin monitoring.
- To quantify heparin and AT III levels in patients undergoing open-heart surgery during extracorporeal circulation.
Summary:
- A fluorogenic synthetic substrate assay with the "Protopath proteolytic enzyme detection system" enables accurate heparin and AT III measurement.
- Ten open-heart surgery patients showed high initial heparin levels (avg. 6.9 U/ml), decreasing over time.
- AT III levels dropped below 50% due to dilution, with recovery to 70% within two hours post-protamine neutralization.
Impact:
- This method enhances the quality of anticoagulant control in high-dose heparin scenarios.
- Accurate heparin monitoring facilitates safer and more effective anticoagulation management during extracorporeal procedures.
- The study demonstrates a practical approach to overcome limitations in coagulation monitoring during cardiopulmonary bypass.