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- Title
Clues of incomplete reversal of heparin in cardiac surgery.
- Authors
Tiquet, Bérénice; Pihan, Franck; Thomasset, Philippe; Denizou, Michel; Tifrea, Marius; Tifrea, Andreaa; Orsel, Isabelle; Marsaud, Jean Philippe; Jouan, Jérome; Vandroux, David
- Abstract
Objectives: In our center, an unusual rate of patients had abnormalities of hemostasis in immediate postoperative period of cardiac surgery. Our objectives were to identify the cause of these sudden hemostasis abnormalities and to evaluate the performances of point of care coagulation testing. Methods: In this prospective and descriptive study, we included 33 consecutive patients undergoing elective cardiac surgery for 1 month. Heparin-induced anticoagulation and calculation of the protamine dose were tested by the Hemostasis Management System Plus device (Medtronic, Minneapolis, MN, USA). Fifteen minutes after the end of the protamine infusion, activated clotting time (ACT), activated partial thromboplastin time and anti Xa activity were measured. In case of unusual clinical bleeding, a Quantra analysis (Stago, HemoSonics LLC, Charlottesville, VA) was added. Results: Residual antiXa activity >0.2 IU/mL after neutralization was present in 44% of patients. Our investigation concluded incomplete heparin reversal. There was no association between cellular reinfusate and the presence of heparin. The unusual rate of hemostasis abnormalities was explained by a less efficient protamine reversal of heparin. ACT and Clot Time Ratio (CTR, Quantra system) correlated with AntiXa with Spearman's coefficients of 0.85 (p <.0001) and 0.95 (p =.0012), respectively. About ACT, a threshold of 150 seconds had a sensitivity of 85% [58–97] and a specificity of 85% [58–97%] for detection of AntiXa>0.2. For CTR, a threshold of 1.4 had a sensitivity of 67% [30–94] and a specificity of 100% [18–100]. Conclusion: The use of point of care coagulation testing is effective in detecting incomplete reversal of heparin.
- Subjects
MASSACHUSETTS; PREDICTIVE tests; RECEIVER operating characteristic curves; DATA analysis; BLOOD chemical analysis; HEPARIN; FISHER exact test; DESCRIPTIVE statistics; CHI-squared test; MANN Whitney U Test; HEMODYNAMICS; NEUTRALIZATION tests; BLOOD coagulation tests; SURGICAL complications; LONGITUDINAL method; INFUSION therapy equipment; PARTIAL thromboplastin time; RESEARCH methodology; STATISTICS; ELECTIVE surgery; HEMOSTASIS; POINT-of-care testing; CONFIDENCE intervals; DATA analysis software; CARDIAC surgery; SENSITIVITY &; specificity (Statistics); PROTAMINES
- Publication
Perfusion, 2024, Vol 39, Issue 4, p784
- ISSN
0267-6591
- Publication type
Article
- DOI
10.1177/02676591231160268