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The Annals of Thoracic Surgery, Vol 49, 440-444, Copyright © 1990 by The Society of Thoracic Surgeons
S Metz and AS Keats
The activated coagulation time (ACT) is widely used to monitor adequacy of
anticoagulation during cardiopulmonary bypass despite absence of data
establishing an ACT below which adverse outcomes occur. For anticoagulation
before cardiopulmonary bypass, we administered a single dose of heparin
(300 U/kg) to 193 patients and measured ACT and heparin levels at intervals
after administration. No additional heparin was administered to any
patient. Clot formation in the cardiopulmonary bypass circuit and excessive
postoperative chest tube drainage were considered outcomes indicating
inadequate anticoagulation. Cardiopulmonary bypass averaged 59 +/- 23
minutes (range, 30 to 138 minutes). Activated coagulation time values at
every sampling period were normally distributed. In 51 patients (26.4%) ACT
values were less than 400 seconds, including 4 less than 300 seconds, at
some sampling time after heparinization. Patients with low ACT values did
not bleed more postoperatively than those with high ACT values, nor was
bleeding related to heparin level. No clots were found in any perfusion
circuit. We conclude that a minimum ACT value for adequacy of
heparinization is not yet defined but that it is less than 400 seconds.
ARTICLES
Low activated coagulation time during cardiopulmonary bypass does not increase postoperative bleeding
Division of Cardiovascular Anesthesia, Texas Heart Institute, Houston 77225-0345.
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