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The Annals of Thoracic Surgery, Vol 26, 231-240, Copyright © 1978 by The Society of Thoracic Surgeons
JA Young, CT Kisker and DB Doty
The adequacy of anticoagulation during 2 hours of cardiopulmonary bypass at
30 degrees C in 9 rhesus monkeys was determined by measuring the
whole-blood activated clotting time (ACT) and by noting the appearance of
thrombin-altered fibrin (fibrin monomer) and the relative consumption of
clotting factors. Factor V and VIII, the heparin cofactor, antithrombin
III, prothrombin time, partial thromboplastin time, ACT, platelets,
hematocrit, fibrinogen, and fibrin monomer were determined prior to
heparinization and after protamine. In 6 of 9 experiments, fibrin monomer
became positive in the plasma during cardiopulmonary bypass (CPB),
indicating that active coagulation was occurring. In 5 of the 6 animals,
initial ACT was less than 400 seconds, and fibrin monomer appeared within
the first 30 minutes of bypass. In 1 animal with an initial ACT of 439
seconds, fibrin monomer appeared after 60 minutes of bypass, at which time
the ACT was less than 400 seconds. An abnormal level of fibrin monomer was
not detected in 5 pediatric patients with an ACT greater than 450 seconds
during CPB. Our experimental study and clinical data suggest that the lower
limit, as measured by the ACT, for anticoagulant effect to provide
coagulation-free CPB is at least 400 seconds.
ARTICLES
Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer
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