title: Anticoagulation management in patients undergoing open heart surgery by activated clotting time and whole blood heparin concentration.
abstract: OBJECTIVE
  To investigate the changes in perioperative anticoagulation management using a heparin-concentration-based system (HMS), and its effect on postoperative outcome.
  
  
  METHODS
  A total of 39 patients undergoing elective primary open heart surgery were randomly assigned to a heparin-concentration-based system approach (study group: 17 patients) or a standard ACT-based anticoagulation system (control group: 22 patients).
  
  
  RESULTS
  Patients in the study group received a statistically significant higher dose of heparin (median 29000 IU with IQR 22 500-33 500 IU versus median 19 000 IU with IQR 17 775-21 500 IU; p < 0.001) and a smaller dose of protamine (median 170 mg with IQR 145-190 mg versus median 200 mg with IQR 180-250 mg; p = 0.008) compared to the control group. Postoperative platelet count was significantly higher in the study group (164 +/- 45 x 10(9)/L versus 125 +/- 27 x 10(9)/L, p = 0.002). None of the study patients, but six patients in the control group required transfusion of blood products (p = 0.02). No differences were recorded in postoperative antithrombin activity, bleeding, and other clinical outcomes.
  
  
  CONCLUSIONS
  The HMS system, by facilitating maintenance of a stable heparin concentration, and by determining an appropriate dose of protamine, is associated with reduced platelet consumption and does not increase AT-III consumption and postoperative bleeding.
authors.affiliation: Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Hospital, Milan, Italy. pappalardo.federico@hsr.it
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.forename: Annalisa
authors.initials: A
authors.lastname: Franco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Crescenzi
authors.forename: Francesco
authors.initials: F
authors.lastname: De Simone
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000097:blood*; D002315:Cardiopulmonary Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006351:Heart Valves / Q000601:surgery*; D006493:Heparin / Q000008:administration & dosage / Q000097:blood*; D006494:Heparin Antagonists / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage; D013927:Thrombosis / Q000517:prevention & control; D016896:Treatment Outcome; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin