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Related Experiment Videos

Individual responses to heparinization for extracorporeal circulation

R H Friesen, A J Clement

    The Journal of Thoracic and Cardiovascular Surgery
    |December 1, 1976
    PubMed
    Summary

    Individual responses to heparin vary significantly, impacting extracorporeal circulation (ECC) protocols. Monitoring coagulation with the BART test revealed personalized heparin needs, optimizing dosage and ensuring safe protamine reversal.

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    Area of Science:

    • Cardiovascular Surgery
    • Anesthesiology
    • Pharmacology

    Background:

    • Heparinization protocols for extracorporeal circulation (ECC) may be suboptimal due to wide variations in individual patient responses.
    • Effective anticoagulation management is critical during open cardiac operations requiring ECC.

    Purpose of the Study:

    • To investigate the variability of individual heparin response during ECC.
    • To evaluate the efficacy of the Blood Activated Recalcification Time (BART) test for monitoring heparinization.
    • To assess the impact of BART-guided heparin management on anticoagulation and protamine reversal.

    Main Methods:

    • Thirty-nine patients undergoing open cardiac surgery with ECC were anticoagulated using a standard protocol.
    • The Blood Activated Recalcification Time (BART) test was employed to monitor the coagulation state intraoperatively.

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  • Heparin dosage adjustments were made based on BART results.

    • Main Results:

    • Significant variations in heparin dose-response and heparin activity decay were observed among patients.
    • No patients were found to be under-heparinized.
    • Many patients exhibited prolonged BART times, indicating effective anticoagulation without the need for additional heparin doses.
    • BART monitoring facilitated a reduction in total heparin dosage by allowing the elimination of incremental doses up to 180 minutes of ECC.
    • Protamine reversal was adequate in all patients, irrespective of their individual heparin response.

    Conclusions:

    • Individual heparin response during ECC is highly variable.
    • The BART test is a valuable tool for monitoring intraoperative coagulation status and guiding heparinization.
    • BART-guided heparin management can optimize anticoagulation, reduce total heparin dose, and ensure safe protamine reversal during ECC.
    • Rapid point-of-care coagulation tests can inform the development of improved heparinization strategies for ECC.