Anticoagulation monitoring during extracorporeal circulation with the Hepcon/HMS device.
OBJECTIVE
The objective of our study was to compare the standard protocol of anticoagulation to the Hepcon/HMS.


METHODS
This study included forty-four patients who underwent coronary bypass grafting surgery (CABG), or biological aortic valve replacement (AVR). Unfractionated heparin (UH) was used for patients who underwent operations in the control group (n = 22) (300U/Kg of UH with a goal of an ACT of 400s). The heparin was antagonized dose/dose by protamine. For the patients who underwent operations in the HMS group (n = 22), the heparin and protamine doses were assessed by the Hepcon/HMS device.


RESULTS
The sex ratio amounted to 1.93 (29 men and 15 women) and the mean age was 70 ± 11 years. The patients in the HMS group had a chest closure time that was significantly shorter than patients in the control group. The times were, respectively, 42 ± 15 minutes and 68 ± 27 minutes (p = 0.001). The protamine/heparin ratio was significantly lower in the HMS group (0.62 ± 0.13 vs. 1 ± 0.11) (p = 0.0001). The postoperative bleeding amounted to 804 ± 729 ml in the HMS group versus 1416 ± 1103 in the control group (p = 0.016). In multivariate linear regression analysis, only two independent factors were significantly associated with bleeding: the Hepcon/HMS (OR = 0.1-p = 0.03) and the preoperative hemoglobin rate (OR = 1.4 - p = 0.05). Postoperatively, within 72 hours, the red blood cell transfusion was 1.04 ± 1.5 units for the HMS group and 2.1 ± 1.87 units for the control group (p = 0.05).


CONCLUSIONS
During cardiac surgery under CPB, heparin and protamine titration with the Hepcon/HMS device could predict a lower protamine dose and lower postoperative bleeding without higher thromboembolic events, and lower perioperative red blood cell transfusion with a shorter chest closure time.
Anesthesiology Unit, South Hospital, Amiens, France.
N
N
Noui
E
E
Zogheib
K
K
Walczak
A
A
Werbrouck
A Ben
AB
Amar
H
H
Dupont
T
T
Caus
J P
JP
Remadi
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001021:Aortic Valve / Q000601:surgery; D001026:Coronary Artery Bypass; D005112:Extracorporeal Circulation; D006470:Hemorrhage / Q000097:blood / Q000628:therapy; D006493:Heparin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods*; D011184:Postoperative Period; D011479:Protamines / Q000097:blood; D013997:Time Factors
D000925:Anticoagulants; D011479:Protamines; D006493:Heparin