| Clinical Studies of Anticoagulant
Therapy by Monitoring of Heparin Concentration |
(Department of Cardiovascular Surgery, Fukushima
Medical University, School of Medicine, Fukushima, Japan)
| Koki Takahashi |
Shunichi Hoshino |
Fumio Iwaya |
| Tuguo Igari |
Hirono Satokawa |
Takashi Ono |
| Shinya Takase |
Kazuya Sato |
Koichi Sato |
| Yukitoki Misawa |
|
|
|
The activated clotting time (ACT)
is used to assess adequacy of anticoagulation during cardiopulmonary
bypass (CPB). However, ACT values during CPB do not correlate
with heparin concentration and are affected by variations of
such factors as hypothermia and hemodilution. ACT is also used
to estimate protamine doses, because excess protamine may result
in hypotension and an increase in bleeding after CPB. This study
was designed to evaluate the effect of heparin and protamine
administration that were administered based on whole blood heparin
concentration using Hepcon/HMS (HC group) on the incidence of
bleeding and blood transfusion after CPB. We treated 32 of adult
cases and 36 pediatric cases. For the control group (NC group),
an initial fixed dose of 300U/kg heparin was administered and
if the ACT was less than 400s an additional fixed dose of 100U/kg
heparin was administered. Heparin was neutralized with an initial
fixed dose of protamine. For the HC group, the initial dose of
heparin and the additional dose of heparin were based on an automated
heparin dose response assay. The initial dose of protamine was
based on the residual heparin concentration. The patients in
the HC group received greater doses of heparin and lower doses
of protamine than the patients in the NC group. In the pediatric
HC group, the amount of TAT, PIC and D-dimer post CPB were smaller
than those in the NC group. Operative time and closure time were
similar the two groups. Operative bleeding, mediastinal chest
tube drainage in the postoperative period were similar in the
two groups. The volume of total blood transfusion was also comparable
in the two groups. In conclusion, the monitoring of heparin concentration
during CPB in children was effective for the maintenance of coagulation
factors.
Jpn. J. Cardiovasc. Surg. 30: 230-236 (2001) |
|
