Clinical Studies of Anticoagulant Therapy by Monitoring of Heparin Concentration Koki Takahashi, Shunichi Hoshino, Fumio Iwaya, Tuguo Igari, Hirono Sa

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1 Clinical Studies of Anticoagulant Therapy by Monitoring of Heparin Concentration Koki Takahashi, Shunichi Hoshino, Fumio Iwaya, Tuguo Igari, Hirono Satokawa, Takashi Ono, Shinya Takase, Kazuya Sato, Koichi Sato and Yukitoki Misawa (Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Japan) The activated clotting time (ACT) is used to assess adequacy of anticoagulation during cardiopulmonary bypass (CPB). However, ACT values during CPB do not correlate with heparin concentration and are affected by variations of such factors as hypothermia and hemodilution. ACT is also used to estimate protamine doses, because excess protamine may result in hypotension and an increase in bleeding after CPB. This study was designed to evaluate the effect of heparin and protamine administration that were administered based on whole blood heparin concentration using Hepcon/HMS (HC group) on the incidence of bleeding and blood transfusion after CPB. We treated 32 of adult cases and 36 pediatric cases. For the control group (NC group), an initial fixed dose of 300U/kg heparin was administered and if the ACT was less than 400s an additional fixed dose of 100U/kg heparin was administered. Heparin was neutralized with an initial fixed dose of protamine. For the HC group, the initial dose of heparin and the additional dose of heparin were based on an automated heparin dose response assay. The initial dose of protamine was based on the residual heparin concentration. The patients in the HC group received greater doses of heparin and lower doses of protamine than the patients in the NC group. In the pediatric HC group, the amount of TAT, FTC and D-dimer post CPB were smaller than those in the NC group. Operative time and closure time were similar the two groups. Operative bleeding, mediastinal chest tube drainage in the postoperative period were similar in the two groups. The volume of total blood transfusion was also comparable in the two groups. In conclusion, the monitoring of heparin concentration during CPB in children was effective for the maintenance of coagulation factors. Jpn. J. Cardiovasc. Surg. 30: (2001)

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7 1) Foster, E. D., Spector, J. I. and Talarico, L.: Polybrene neutralization as a means of monitoring heparin therapy for extracorporeal circulation. Ann. Thorac. Surg. 23: , ) Babka, R., Colby, C. and El-Etr, A.: Monitoring of intraarterial heparinization and blood loss following cardiopulmonary bypass surgery. J. Thorac. Cardiovasc. Surg. 73: , ) Young, J. A., Kisker, C. T. and Doty, D. B.: Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer. Ann. Thorac. Surg. 26: , ) Despotis, G. J., Joist, J. H. and Hougue, C. W.: The impact of heparin concentration and activated clotting time monitoring on blood conservation: a prospective, randomized evaluation in patients undergoing cardiac operation. J. Thorac. Cardiovasc. Surg. 110: 46, ) DeSmet, A. A. E. A., Joen, M. C. N. and van Oeveren, W.: Increased anticoagulation during cardiopulmonary bypass by aprotinin. J. Thorac. Cardiovasc. Surg. 100: , ) Despotis, G. J., Summerfield, A. L. and Joist, J. H.: Comparison of activated coagulation time and whole blood heparin measurements with laboratory plasma anti-xa heparin concentration in patients having cardiac operations. J. Thorac. Cardiovasc. Surg. 108: , ) Mattox, K. L., Guinn, G. A. and Rubio, P. A.: Use of the activated coagulation time in intraoperative heparin reversal for cardiopulmonary operations. Ann. Thorac. Surg. 19: , ) Hird, R. B., Crawford, F. A. and Mukherjee, R.: Effects adrenergic responsiveness. Ann. Thorac. Surg. 57: 1066, ) Ellison, N., Edmunds, L. H. and Colman, R. W.: Platelet aggregation following heparin and protamine administration. Anesthesiology 48: 65, ) Doty, D. B., Knott, H. W. and Hoyt, J. T.: Heparin dose for accurate anticoagulation in cardiac surgery. J. Cardiovasc. Surg. 20: , ) D'Errico, C., Shayevitz, J. R. and Martindale, S. J.: Age-related differences in heparin sensitivity and heparin-protamine interactions in cardiac surgery patients. J. Cardiothorac. Vasc. Anesth. 10: , ) Despotis, G. J., Joist, J. H. and Hogue, C. W., Jr.: More effective suppression of hemostatic system activation in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather than ACT. Thromb. Haemost. 76: , 1996.

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