title: The plasma supplemented modified activated clotting time for monitoring of heparinization during cardiopulmonary bypass: a pilot investigation.
abstract: The standard celite or kaolin activated clotting time (ACT) correlates poorly with heparin levels during cardiopulmonary bypass (CPB). We compared a modified kaolin ACT, in which plasma was supplemented, to a standard undiluted kaolin ACT for monitoring heparin levels during CPB. Fifteen patients undergoing normothermic CPB were enrolled in this prospective study. Heparin management was performed according to the Hepcon HMS results (Medtronic, Minneapolis, MN). The ACTs were performed with the ACT II device (Medtronic). Hepcon HMS calculations, standard kaolin ACTs, and plasma supplemented modified ACTs (mACTs), prepared by diluting blood samples 1:1 with human plasma (Behring, Marburg, Germany), were measured every 30 min during CPB. The data obtained were correlated to the plasma chromogenic anti-Xa activity as a reference assay for heparin levels. A total of 64 samples were evaluated. The chromogenic anti-Xa activity ranged from 0.2 to 5.5 IU/mL. The Hepcon HMS calculations ranged from 2.7-8.2 IU/mL of heparin, the standard ACT ranged from 424 to >999 s, and the mACT ranged from 210 to 801 s. The correlation to the chromogenic anti-Xa method was r = 0.43 for the standard kaolin ACT and r = 0.69 for the plasma mACT. The plasma mACT provided an improved correlation to chromogenically measured levels of anti-Xa activity during CPB. The improved correlation most likely results from a correction of the effects of the impairment of the coagulation system caused by hemodilution and consumption of procoagulants on extracorporeal surfaces.
  
  
  CONCLUSIONS
  During cardiopulmonary bypass, the plasma modified kaolin activated clotting time (ACT) provides a better correlation with heparin levels than the standard kaolin ACT.
authors.affiliation: Department of Anesthesia, Deutsches Herzzentrum Berlin, Charité, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany. Koster@dhzb.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.forename: George
authors.initials: G
authors.lastname: Despotis
authors.forename: Marcus
authors.initials: M
authors.lastname: Gruendel
authors.forename: Thomas
authors.initials: T
authors.lastname: Fischer
authors.forename: Michael
authors.initials: M
authors.lastname: Praus
authors.forename: Herman
authors.initials: H
authors.lastname: Kuppe
authors.forename: Jerrold H
authors.initials: JH
authors.lastname: Levy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000097:blood / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D002315:Cardiopulmonary Bypass; D005260:Female; D006400:Hematocrit; D006493:Heparin / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D007616:Kaolin; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010865:Pilot Projects; D011446:Prospective Studies; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D007616:Kaolin; D006493:Heparin