Point of care management of heparin administration after heart surgery: A randomized, controlled trial.
OBJECTIVE
Determination of activated partial thromboplastin time (aPTT) is used in coagulation management after heart surgery. Results from the central laboratory take long to be obtained. We sought to shorten the time to obtain coagulation results and the desired coagulation state and to reduce blood loss and transfusions using point of care (POC) aPTT determination.


METHODS
Randomized, controlled trial.


METHODS
University-affiliated 20-bed surgical ICU.


METHODS
Forty-two patients planned for valve surgery (Valves) and 84 for coronary artery bypass grafting (CABG) with cardiopulmonary bypass.


METHODS
Valves and CABG were randomized to postoperative coagulation management monitored either by central laboratory aPTT (Lab group) or by POC aPTT (POC group). Heparin was administered according to guidelines.


RESULTS
POC aPTT results were available earlier than Lab aPTT after venipuncture in Valves (3 +/- 2 vs. 125 +/- 68 min) and in CABG (3 +/- 4 vs. 114 +/- 62 min). Heparin was introduced earlier in the POC group in Valves (7 +/- 23 vs. 13 +/- 78 h, p = 0.01). Valves of the POC group bled significantly less than Valves in the Lab group (647 +/- 362 ml vs. 992 +/- 647 ml, p < 0.04), especially during the first 8 h after ICU admission. There was no difference in bleeding in CABG (1074 +/- 869 ml vs. 1102 +/- 620, p = NS). In Valves, fewer patients in the POC group than in the Lab group needed blood transfusions (1/21 vs. 8/21; p = 0.03). No difference was detected in CABG.


CONCLUSIONS
In Valves in the POC group the time to the desired coagulation state was reduced, as was the thoracic blood loss, reducing the number of patients transfused. This improvement was not observed in CABG. Side effects were similar in the two groups.
Merlani
Paolo G
PG
Service of Surgical Intensive Care, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University of Geneva Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland. paolo.merlani@hcuge.ch
Chenaud
Catherine
C
Cottini
Silvia
S
Reber
Guido
G
Garnerin
Philippe
P
de Moerloose
Philippe
P
Ricou
Bara
B
D001778:Blood Coagulation Disorders / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures; D004334:Drug Administration Schedule; D017707:Erythrocyte Transfusion; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D010314:Partial Thromboplastin Time; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000209:etiology; D012044:Regression Analysis; D013997:Time Factors; D016896:Treatment Outcome
D006493:Heparin