title: Evaluation of the activated clotting time and activated partial thromboplastin time for the monitoring of heparin in adult extracorporeal membrane oxygenation patients.
abstract: BACKGROUND
  Historically, the activated clotting time (ACT) has been the preferred monitoring test of the heparin effect in extracorporeal membrane oxygenation (ECMO) patients. However, few adult studies have evaluated its correlation to the heparin dose or other monitoring tests, such as the activated partial thromboplastin time (aPTT). This retrospective study sought to evaluate the correlation between the heparin dose and these monitoring tests.
  
  
  METHODS
  Patients administered a heparin drip during ECMO were included in this study. The primary endpoints were the correlation between heparin dose and ACT or aPTT and the relationship between paired ACT and aPTT samples.
  
  
  RESULTS
  Forty-six patients met the criteria for study inclusion. A better correlation was observed for heparin dose and aPTT (Pearson product-moment correlation coefficient (r) = 0.43 - 0.54) versus ACT (r = 0.11 - 0.14). Among the paired sample data, ACT values did not differ significantly between Groups two (aPTT 60 - 75 seconds) and three (aPTT >75 seconds).
  
  
  CONCLUSIONS
  The heparin dose correlated better with aPTT relative to ACT and, thus, may be considered a more effective tool for the dosing of heparin in adult ECMO patients. Paired ACT and aPTT sample data suggested a poor relationship between these two anticoagulant monitoring tests.
authors.affiliation: Houston Methodist Hospital, Department of Pharmacy, Houston, TX, USA Scripps Mercy Hospital, Department of Pharmacy, San Diego, CA, USA stevenatallah@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Atallah
authors.affiliation: Houston Methodist Hospital, Department of Pharmacy, Houston, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Liebl
authors.affiliation: Houston Methodist Hospital, Department of Pharmacy, Houston, TX, USA.
authors.forename: K
authors.initials: K
authors.lastname: Fitousis
authors.affiliation: Houston Methodist Hospital, Department of Pharmacy, Houston, TX, USA.
authors.forename: F
authors.initials: F
authors.lastname: Bostan
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: F
authors.initials: F
authors.lastname: Masud
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010314:Partial Thromboplastin Time; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: activated clotting time; anticoagulation; extracorporeal membrane oxygenation; heparin; partial thromboplastin time