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Activated coagulation time: one tube or two?

J A Bennett1, J C Horrow

  • 1Medical College of Pennsylvania, Philadelphia, USA.

Journal of Cardiothoracic and Vascular Anesthesia
|June 1, 1996
PubMed
Summary
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Using the average of two activated coagulation time (ACT) tests, rather than a single test, is recommended for managing heparin during cardiopulmonary bypass surgery. This method ensures more consistent heparin administration.

Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Laboratory Medicine

Background:

  • Accurate activated coagulation time (ACT) monitoring is crucial for heparin management during cardiopulmonary bypass (CPB).
  • Current practice often relies on single ACT measurements, potentially leading to management variability.

Purpose of the Study:

  • To compare the efficacy of single ACT determination versus the average of two simultaneous ACT values for guiding heparin administration.
  • To evaluate the impact of preoperative heparin exposure on ACT management strategies.

Main Methods:

  • A prospective study was conducted in cardiac operating rooms involving patients undergoing CPB.
  • Activated coagulation time (ACT) was performed in duplicate for all patients.
  • Heparin management decisions based on a single ACT value were compared to those based on the average of duplicate ACT values.

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Main Results:

  • Out of 683 paired ACT determinations in 100 patients, 83% resulted in identical heparin management recommendations between the two methods.
  • The single-tube method would have led to 34% more supplemental heparin administrations compared to the average method.
  • The single-tube method would have incorrectly withheld heparin 16% of the time when the average method indicated administration.

Conclusions:

  • The study recommends employing a two-tube average method for ACT to guide heparin administration during CPB.
  • Preoperative heparin exposure did not significantly affect the outcomes of either ACT management strategy.