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FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 1999 Ottobre;40(5):645-51

CARDIAC PAPERS 

 ORIGINAL ARTICLES

Real ­time meas­ure­ment of hep­arin con­cen­tra­tion ­during car­di­o­pul­mo­nary ­bypass

Hashimoto K., Sasaki T., Hachiya T., Takakura H., Onoguchi K., Nagahori R., Takeuchi S.

From the Depart­ment of Car­di­o­vas­cular Sur­gery Sai­tama ­Ohara Car­di­o­vas­cular ­Center Konan, ­Osato-gun, Sai­tama-ken, ­Japan

Back­ground. A hep­arin/pro­ta­mine titra­tion ­system for meas­ure­ment of hep­arin ­levels (­Hepcon) is prom­ising for effi­cient anti­co­ag­u­la­tion ­during car­di­o­pul­mo­nary ­bypass (CPB).
­Methods. ­Fifty-­seven ­patients sub­jected to CPB ­were ­divided ­into two ­groups, con­trol (n=24) and ­Hepcon ­groups (n=33). The ­Hepcon ­group was fur­ther ­divided ­into ­three sub­groups ­according to per­fu­sion tem­per­a­ture. For the con­trol ­group, con­ven­tional admin­is­tra­tion of an anti­co­ag­u­lant (300 IU/kg of hep­arin) and ­reversal pro­tocol (hep­arin 1: pro­ta­mine 1) was per­formed. For the ­Hepcon ­group, a hep­arin ­dose-­response ­assay ­directed the ­initial ­dose of hep­arin. ­Hepcon ­also deter­mined the ­dose of pro­ta­mine by the titra­tion. The ­initial ­dose of hep­arin in the con­trol ­group (300 IU/kg) was sta­tis­ti­cally ­less ­than ­that of ­Hepcon ­group (360±80 IU/kg).
­Results. In the ­Hepcon ­group, the sen­si­tivity to hep­arin was cor­re­lated ­with coag­u­la­tion ­time (r=-0.78) and anti­thrombin III ­levels (r=0.70), and indi­vidual dif­fer­ence of sen­si­tivity ­resulted in a ­wide ­range of ­dosage (160 to 490 IU/kg). A ­strong cor­re­la­tion was ­observed ­between ­plasma and ­whole ­blood con­cen­tra­tion of hep­arin (r=0.86). How­ever, ­they did not cor­re­late ­with ACT ­values. Per­fu­sion tem­per­a­ture ­didn’t ­affect the hep­arin ­level, but did the ACT ­value. In the ­Hepcon ­group, the ­dose of pro­ta­mine was sig­nif­i­cantly ­less and ­adverse ­events ­were ­rare.
Con­clu­sions. In con­clu­sion, ­whole ­blood hep­arin meas­ure­ments cor­re­lated ­well ­with ­plasma hep­arin con­cen­tra­tion. Pro­ta­mine titra­tion of hep­arin ­reduced the ­dose of pro­ta­mine and ­decreased the ­chance of ­adverse reac­tions.

lingua: Inglese


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