title: Comparison of heparin administration using the Rapidpoint Coag and Hepcon HMS.
abstract: A retrospective chart review was conducted of patients who underwent cardiopulmonary bypass (CPB) to compare the quantities of heparin administered, postoperative blood loss, and homologous blood products transfused during their procedure and subsequent stay in the intensive care unit. The primary purpose of this review was to determine if any difference in heparin administration resulted when two different devices were used for dosing and monitoring heparin. Postoperative blood loss and amount of blood products transfused were also quantified, as any differences would potentially be a result of a difference in administration of heparin. The first group (n = 341) underwent CPB using the Hepcon HMS, Medtronic Inc., Minneapolis, MN, for heparin dosing and monitoring. The Rapid Point Coag, Bayer Healthcare LLC, Tarrytown, NY was used for the second group (n = 345). The two populations were compared for similarity on: age, body surface area (BSA), CPB time (minutes), aortic-cross clamp time (minutes), baseline activated clotting time, and baseline hematocrit. No significant difference was found between the two groups. The second group, using the Rapidpoint Coag, received less heparin during CPB than the group using the Hepcon HMS. In addition, there were decreases in amounts of some blood products transfused as well as mediastinal drainage from the Hepcon HMS to the Rapidpoint Coag group. A summary of the findings can be found in Table 1. A secondary purpose of this study was to determine the influence of hemodilution on the Heparin Management Test (HMT). Citrated whole blood was diluted to varying degrees at various concentrations to determine whether hemodilution with crystalloid would alter the HMT measurements. At all heparin levels and degrees of dilution, the HMT remained stable, with coefficients of variation (CV) of less than 5% at all heparin levels even while incorporating excessive crystalloid dilution (up to 75%).
authors.affiliation: Charleston Area Medical Center, Charleston, West Virginia 25304, USA. jason.newsome@camc.org
authors.forename: Jason
authors.initials: J
authors.lastname: Newsome
authors.forename: Kerri
authors.initials: K
authors.lastname: Stipanovich
authors.forename: Sarah
authors.initials: S
authors.lastname: Flaherty
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001780:Blood Coagulation Tests / Q000295:instrumentation / Q000379:methods; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D003325:Coronary Care Units / Q000706:statistics & numerical data; D016903:Drug Monitoring / Q000295:instrumentation*; D015951:Factor Xa; D005260:Female; D006400:Hematocrit; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D006493:Heparin; D015951:Factor Xa