title: Thromboprophylaxis With Heparin During Orthotopic Liver Transplantation: Comparison of Hepcon HMS Plus and Anti-Xa Assays for Low-Range Heparin.
abstract: OBJECTIVE
  The purpose of this study was to compare the agreement between two heparin assays, Hepcon HMS plus/Kaolin-ACT and Anti-Xa, and their predictive power in detecting circulating heparin levels post-reperfusion of the liver graft when compared with thromboelastogram (TEG) r time ratio in patients undergoing orthotopic liver transplantation (OLT).
  
  
  METHODS
  Prospective, observational cohort study design.
  
  
  METHODS
  Single center, university hospital.
  
  
  METHODS
  Thirty-eight consecutive adults who had undergone liver transplant.
  
  
  METHODS
  None.
  
  
  RESULTS
  Paired arterial blood samples were collected before surgical incision, 5 minutes after administration of an average dose of 2,054±771 units of intravenous unfractionated heparin before caval cross-clamping, 5 minutes after portal reperfusion, 5 minutes after hepatic artery reperfusion, and 1 hour after hepatic artery reperfusion. The observations that heparin assay measurements were within the predetermined limits of agreement, strongly suggested the two heparin assays (Hepcon HMS plus and Anti-Xa assay) are interchangeable during prophylactic heparin dose therapy during OLT. Post-reperfusion, receiver operating characteristic curve analysis revealed high accuracy in measuring circulating heparin levels with both Anti-Xa and Hepcon HMS assays when compared with the TEG r time ratio assay.
  
  
  CONCLUSIONS
  The point-of-care Hepcon HMS plus/Kaolin-ACT (activated clotting time) assay appeared to be a reliable alternative to the more expensive and laboratory-required Anti-Xa assay in monitoring the response to intravenous heparin in patients undergoing OLT.
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA. Electronic address: rnicolauraducu@ochsner.org.
authors.forename: Ramona
authors.initials: R
authors.lastname: Nicolau-Raducu
authors.affiliation: Department of Hematology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Elise
authors.initials: E
authors.lastname: Occhipinti
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Marshall
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Koveleskie
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Donald
authors.initials: D
authors.lastname: Ganier
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Brian
authors.initials: B
authors.lastname: Evans
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: William
authors.initials: W
authors.lastname: Daly
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Brian
authors.initials: B
authors.lastname: Fish
authors.affiliation: Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Ari J
authors.initials: AJ
authors.lastname: Cohen
authors.affiliation: Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Trevor W
authors.initials: TW
authors.lastname: Reichman
authors.affiliation: Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: David
authors.initials: D
authors.lastname: Bruce
authors.affiliation: Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Humberto
authors.initials: H
authors.lastname: Bohorquez
authors.affiliation: Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: John
authors.initials: J
authors.lastname: Seal
authors.affiliation: Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Emily
authors.initials: E
authors.lastname: Ahmed
authors.affiliation: Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Ian
authors.initials: I
authors.lastname: Carmody
authors.affiliation: Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: George
authors.initials: G
authors.lastname: Loss
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rayburn
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Bobby
authors.initials: B
authors.lastname: Nossaman
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000097:blood; D001780:Blood Coagulation Tests / Q000379:methods; D015331:Cohort Studies; D065427:Factor Xa Inhibitors / Q000008:administration & dosage*; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D028321:Plant Preparations / Q000008:administration & dosage*; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; C584915:Hepcon; D028321:Plant Preparations; D006493:Heparin
keywords: Anti-Xa assays, throboelastograph (TEG); Hepcon HMS plus; heparin; liver transplantation