Detection of early incomplete heparin reversal following congenital cardiac surgery: A single-center retrospective observational study.
Anticoagulants
/ therapeutic use
Blood Coagulation
/ drug effects
Blood Coagulation Tests
Cardiopulmonary Bypass
/ methods
Female
Heart Defects, Congenital
/ blood
Heparin
/ therapeutic use
Heparin Antagonists
/ therapeutic use
Humans
Infant
Infant, Newborn
Male
Protamines
/ therapeutic use
Retrospective Studies
Cardio-pulmonary bypass
Congenital cardiac surgery
Heparin
Protamine
Journal
Thrombosis research
ISSN: 1879-2472
Titre abrégé: Thromb Res
Pays: United States
ID NLM: 0326377
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
26
06
2019
revised:
09
08
2019
accepted:
17
08
2019
pubmed:
25
8
2019
medline:
28
4
2020
entrez:
25
8
2019
Statut:
ppublish
Résumé
The monitoring of unfractionated heparin (UFH) reversal with protamine plays a crucial role for bleeding management after cardio-pulmonary bypass (CPB) in congenital cardiac surgery. The current standard for the monitoring of UFH and its reversal is the activated clotting time (ACT). While the ACT is affected by other CPB-associated pathologies a bedside technique with more specific heparin-related results would be very helpful. The new point-of-care viscoelastic test Haemonetics TEG® 6s, which is based on small blood samples may fulfill these requirements. This study aimed to compare the new TEG with laboratory assays. A retrospective observational study was performed on 40 children with a median age of 130 days (interquartile range 13 to 310 days) undergoing congenital cardiac surgery. After separation of CPB, test results of the TEG® 6s, ACT, anti-Xa for UFH and PTT were compared and correlated with each other. No clinically relevant correlation was found for heparin specific TEG-derived parameters (CK/CKH R-time ratio) with ACT, PTT and anti-Xa measurements. After grouping in dependence to the CK/CKH R-time in patients with and without successful heparin reversal again no significant difference of anti-Xa-UFH-levels, post-/pre-CPB ratio of the PTT and ACT was observed. In pediatric patients undergoing cardiac surgery using CPB there is no association of conventional coagulation tests and TEG-derived results. While bedside viscoelastic tests deliver rapid results, further studies are needed to compare whether the TEG based management of incomplete heparin reversal is sufficient to monitor heparin reversal and to reduce blood loss.
Sections du résumé
BACKGROUND
BACKGROUND
The monitoring of unfractionated heparin (UFH) reversal with protamine plays a crucial role for bleeding management after cardio-pulmonary bypass (CPB) in congenital cardiac surgery. The current standard for the monitoring of UFH and its reversal is the activated clotting time (ACT). While the ACT is affected by other CPB-associated pathologies a bedside technique with more specific heparin-related results would be very helpful. The new point-of-care viscoelastic test Haemonetics TEG® 6s, which is based on small blood samples may fulfill these requirements. This study aimed to compare the new TEG with laboratory assays.
METHODS
METHODS
A retrospective observational study was performed on 40 children with a median age of 130 days (interquartile range 13 to 310 days) undergoing congenital cardiac surgery. After separation of CPB, test results of the TEG® 6s, ACT, anti-Xa for UFH and PTT were compared and correlated with each other.
RESULTS
RESULTS
No clinically relevant correlation was found for heparin specific TEG-derived parameters (CK/CKH R-time ratio) with ACT, PTT and anti-Xa measurements. After grouping in dependence to the CK/CKH R-time in patients with and without successful heparin reversal again no significant difference of anti-Xa-UFH-levels, post-/pre-CPB ratio of the PTT and ACT was observed.
CONCLUSIONS
CONCLUSIONS
In pediatric patients undergoing cardiac surgery using CPB there is no association of conventional coagulation tests and TEG-derived results. While bedside viscoelastic tests deliver rapid results, further studies are needed to compare whether the TEG based management of incomplete heparin reversal is sufficient to monitor heparin reversal and to reduce blood loss.
Identifiants
pubmed: 31445451
pii: S0049-3848(19)30338-X
doi: 10.1016/j.thromres.2019.08.008
pii:
doi:
Substances chimiques
Anticoagulants
0
Heparin Antagonists
0
Protamines
0
Heparin
9005-49-6
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
33-38Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.