Abstract
An excessive perioperative blood loss, that requires transfusion of blood products, sometimes occurs in patients undergoing cardiopulmonary bypass for cardiac surgery. Blood loss and transfusion requirements in these patients may be reduced with a better control of heparin treatment and its reversal. Blood component administration in patients with excessive post-cardiopulmonary bypass bleeding has been empiric for a long time due to turnaround times of laboratory coagulation tests. Devices are now available for rapid, point-of-care assessment of hemostasis alterations to allow an appropriate, targeted therapy. In particular, a quick evaluation of platelet and coagulation defects with new point-of-care devices can optimize the administration of pharmacological and transfusion-based therapy in patients with excessive bleeding after cardiopulmonary bypass.
Highlights
During cardiopulmonary bypass (CPB) high dose heparin is needed to prevent thrombosis of circuits used during extracorporeal circulation (ECC)
activated clotting time (ACT) has been used for many years to monitor heparin treatment specially in those conditions in which high blood concentrations cannot be accurately evaluated by aPTT [3]
A recent report [16] has demonstrated that this test in cardiac surgery has performances similar to those of Hemochron ACT; it tends to have significant shorter values than ACT after bolus of heparin and during ECC with condition of hypothermia
Summary
During cardiopulmonary bypass (CPB) high dose heparin is needed to prevent thrombosis of circuits used during extracorporeal circulation (ECC). Clinical evaluation included 56 samples from CPB cardiac surgery patients (celite ACT values up to 744 secs) and reported a mean differences between duplicates of 7.5 secs.
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