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[Effect of hemodilution with dextran and albumin on activated clotting time (ACT)]
1Department of Anesthesia, Kanagawa Prefectural Cardiovascular and Respiratory Center, Yokohama.
Insights
Hemodilution using dextran or albumin solutions significantly increases activated clotting time (ACT) and enhances heparin
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Hemodilution with colloid solutions can affect blood coagulation.
- Maintaining adequate anticoagulation is crucial during cardiopulmonary bypass (CPB).
Purpose of the Study:
- To evaluate the impact of hemodilution on activated clotting time (ACT) during coronary artery bypass grafting (CABG).
Main Methods:
- 156 patients undergoing elective CABG were divided into three groups: no hemodilution, normovolemic hemodilution with Dextran 40, and hemodilution with albumin and lactated Ringer solution.
- Systemic heparin was administered, and ACT was monitored using Hemochron 400, aiming for values >400 seconds.
- Supplemental heparin doses were adjusted to maintain target ACT levels.
Main Results:
- Patients in the hemodilution groups (Dextran 40, albumin/Ringer) required fewer supplemental heparin doses to achieve target ACT compared to the non-hemodilution group.
- ACT values were significantly higher at all sampling points in the hemodilution groups versus the control group.
- Hemodilution with dextran and albumin demonstrated increased ACT and potentiated heparin's anticoagulant effect.
Conclusions:
- Hemodilution with Dextran 40 or albumin/lactated Ringer solution effectively increases ACT values.
- These hemodilution strategies enhance the anticoagulant effect of heparin during CABG surgery.
Abstract:
Hemodilution with colloid solution is known to influence blood coagulation. To evaluate the effectiveness of hemodilution on ACT, 156 patients undergoing elective coronary artery bypass grafting were studied. Patients were divided into three groups (Group I of 52: without hemodilution, Group II of 52: normovolemic hemodilution with Dextran 40, Group III of 52: albumin and lactated Ringer solution). Systemic heparin was given (300 IU.kg-1. ACT was measured by Hemochron 400 and maintained higher than 400 seconds with supplemental dose of heparin. Sampling was performed after induction in Group I, after hemodilution in other groups, after heparin administration, was after start of CPB. More supplemental dose of heparin were required to achieve the lower limit of ACT (400 seconds) in the group I. The ACT at any sampling point was significantly higher in the group II and III than in the group I. In conclusion, hemodilution with dextran and albumin increased ACT values and heparin effect.