Article of the Month – December 2019

Anticoagulation Management and Heparin Resistance during Cardiopulmonary Bypass: a Survey of Society of Cardiovascular Anesthesiologists Members

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629168/pdf/ane-129-e41.pdf

DOI: 10.1213/ANE.0000000000003981

Published: Anesth Analg Aug 2019; 129 (2): e41-e44

Authors: 

Roman M Sniecinski, Elliott Bennett-Guerrero, Linda Shore-Lesserson.

Article Description:

  • The reported incidence of “heparin resistance” during using CPB ranges from 4% to 26%, which is highly dependent on the initial bolus dose of heparin and the desired activated clotting time (ACT) target for CPB initiation.
  • The authors conducted a survey on the Society of Cardiovascular Anesthesiologists Members to describe both (1) current practice of anticoagulation for initiation and maintenance of CPB and (2) clinician attitudes on heparin resistance and their current use of antithrombin concentrates.
  • The authors analysed 550 responses, giving an effective response rate of 18.5%.

Summary:

  • An empiric weight-based approach to determine the pre-CPB heparin bolus was used by 74.9% of respondents (95% CI, 71.3%–78.5%).
  • Adequate anticoagulation was assessed by targeting a specific ACT for “initiation” of CPB and “during” CPB by 84.7% (95% CI, 81.7%–87.7%) and 88.4% (95% CI, 85.7%–91.1%) of respondents, respectively.
  • For those who used an ACT to determine adequate anticoagulation for CPB initiation, either with or without a heparin level, an ACT value of 400 or 480 seconds was used to initiate CPB by 70.7% of respondents.
  • More than half of the respondents use antithrombin concentrate as a first-line treatment compared to those who administered FFP as a first-line treatment for heparin resistance.

Check this interesting study and look for the results: would this be a plus or change your practice? 

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