Anticoagulation monitoring during extracorporeal circulation with the Hepcon/HMS device.

Abstract

OBJECTIVE:

The objective of our study was to compare the standard protocol of anticoagulation to the Hepcon/HMS.

METHOD:

This study included forty-four patients who underwent coronary bypass grafting surgery (CABG), or biological aortic valve replacement (AVR). Unfractionated heparin (UH) was used for patients who underwent operations in the control group (n = 22) (300U/Kg of UH with a goal of an ACT of 400s). The heparin was antagonized dose/dose by protamine. For the patients who underwent operations in the HMS group (n = 22), the heparin and protamine doses were assessed by the Hepcon/HMS device.

RESULTS:

The sex ratio amounted to 1.93 (29 men and 15 women) and the mean age was 70 ± 11 years. The patients in the HMS group had a chest closure time that was significantly shorter than patients in the control group. The times were, respectively, 42 ± 15 minutes and 68 ± 27 minutes (p = 0.001). The protamine/heparin ratio was significantly lower in the HMS group (0.62 ± 0.13 vs. 1 ± 0.11) (p = 0.0001). The postoperative bleeding amounted to 804 ± 729 ml in the HMS group versus 1416 ± 1103 in the control group (p = 0.016). In multivariate linear regression analysis, only two independent factors were significantly associated with bleeding: the Hepcon/HMS (OR = 0.1-p = 0.03) and the preoperative hemoglobin rate (OR = 1.4 - p = 0.05). Postoperatively, within 72 hours, the red blood cell transfusion was 1.04 ± 1.5 units for the HMS group and 2.1 ± 1.87 units for the control group (p = 0.05).

CONCLUSION:

During cardiac surgery under CPB, heparin and protamine titration with the Hepcon/HMS device could predict a lower protamine dose and lower postoperative bleeding without higher thromboembolic events, and lower perioperative red blood cell transfusion with a shorter chest closure time.

• Authors: N Noui, E Zogheib, K Walczak, A Werbrouck, A Ben Amar, H Dupont, T Caus, J P Remadi
• Journal: Perfusion (Perfusion) Vol. 27 Issue 3 Pg. 214-20 (May 2012) ISSN: 1477-111X [Electronic] England
• PMID: 22301392 (Publication Type: Journal Article)

Chemical References

• Anticoagulants
• Protamines
• Heparin

Topics

• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage, pharmacokinetics)
• Aortic Valve (surgery)
• Coronary Artery Bypass
• Extracorporeal Circulation
• Hemorrhage (blood, therapy)
• Heparin (administration & dosage, pharmacokinetics)
• Humans
• Male
• Monitoring, Physiologic (instrumentation, methods)
• Postoperative Period
• Protamines (blood)
• Time Factors