Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass about Postoperative Drainage and Blood Transfusion

Abstract

Coagulation cascade starts with exsanguination or any contact of blood with an extracorporeal surface.(1-5) Since invention of heparin molecule in 1916, it has been an essential application for cardiopulmonary bypass (CPB). Nowadays during CPB we have been using Activated Clotting Time (ACT) test because it results quicker than other laboratory tests to evaluate anticoagulation of heparin.(6-10) During CPB, high anticoagulation levels would result with unexpected high rate non-surgical bleeding. However, lower anticoagulation doses would end up with high rate of thromboembolic events. Both situations can be related with high mortality or morbidity.(13) There have been guidelines about blood conservation in cardiac surgery but clinical management of anticoagulation during CPB is not standardized.(14) In this respect, so far there has not been an ideal universal ACT value. Most clinics sets ACT target as above 400 – 480 seconds during CPB.(11,12) Over the years most clinics apply 300 IU/kg dose heparin regimen which has been empirically advanced and universally accepted for CPB to reach target ACT values, but this regimen sometimes can lead to higher ACT values.(13) This situation may cause to more postoperative bleeding, more postoperative blood transfusion and prolonged intensive care staying, although heparin is antagonized with protamine at the end of CPB. In this study we would like to compare retrospectively patients under went open heart surgery whom ACT’s during CPB were 400-650 seconds with the patients whom ACT’s were 650 seconds and higher during CPB.