ORIGINAL ARTICLES  CARDIAC PAPERS 

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

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

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.