ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow References
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Ferenc Horkay
Duncan R. Walker
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Horkay, F.
Right arrow Articles by Walker, D. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Horkay, F.
Right arrow Articles by Walker, D. R.

Ann Thorac Surg 1992;53:822-826
© 1992 The Society of Thoracic Surgeons

Articles

Response to heparinization in adults and children undergoing cardiac operations

Ferenc Horkay, FRCS, Paul Martin, BSc*, S.Mano Rajah, FRCP, Duncan R. Walker, FRCS

Departments of Cardiothoracic Surgery and Haematology, Regional Cardiothoracic Centre, Killingbeck Hospital, Leeds United Kingdom

Accepted for publication October 14, 1991.

* Address reprint requests to Dr Martin, Killingbeck Hospital, York Road Leeds LS 14 6UQ, UK.

The activated clotting time is an unreliable index of anticoagulation status during cardiopulmonary bypass procedures. However, modem instrumentation (Hemotec Hepcon HMS) now allows the monitoring of free heparin levels via automated protamine titration. In the present study, the standard procedure of anticoagulation at Killingbeck Hospital, Leeds, was investigated. Twenty-two pediatric patients and 20 adult patients undergoing open heart procedures involving cardiopulmonary bypass were given empirical doses of heparin (3 mg/kg body weight bolus), and activated clotting time was maintained at a level greater than 450 seconds using the Hemochron Timer. Heparin neutralization was performed at the termination of the bypass period using an empirical equivalent (3 mg/kg) of protamine sulfate. Mean free heparin concentration (± standard deviation) fell from 2.26 (± 0.45) mg/kg to 1.39 (± 0.34) mg/kg over the period 10 to 40 minutes on bypass in children. In adults, free heparin level declined from 2.56 (± 0.58) mg/kg to 1.81 (± 0.58) mg/kg over the same period. The biological half-life for heparin was 60 minutes in adults and 35 minutes in pediatric patients. Empirical protamine dosing resulted in excess protamine administration when compared with Hepcon titrated dose requirements: for children: median (range), 80 (12 to 350) versus 33 (12 to 97) mg, p < 0.001; and for adults: 350 (200 to 500) versus 130 (61 to 237) mg, p < 0.001. In conclusion, empirical heparin administration (3 mg/kg) does not result in "steady-state" anticoagulation during cardiopulmonary bypass, and empirical administration of protamine takes no account of interindividual differences in heparin sensitivity and biological half-life, which may be assessed using the Hepcon HMS.




This article has been cited by other articles:


Home page
 Anesth. Analg.Home page
N. A. Guzzetta, T. Bajaj, T. Fazlollah, F. Szlam, E. Wilson, A. Kaiser, S. R. Tosone, and B. E. Miller
A Comparison of Heparin Management Strategies in Infants Undergoing Cardiopulmonary Bypass
Anesth. Analg., February 1, 2008; 106(2): 419 - 425.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
E. B. Mossad, S. Machado, and J. Apostolakis
Bleeding following deep hypothermia and circulatory arrest in children.
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2007; 11(1): 34 - 46.
[Abstract] [PDF]

Home page
 Anesth. Analg.Home page
N. A. Guzzetta, B. E. Miller, K. Todd, F. Szlam, R. H. Moore, and S. R. Tosone
An Evaluation of the Effects of a Standard Heparin Dose on Thrombin Inhibition During Cardiopulmonary Bypass in Neonates
Anesth. Analg., May 1, 2005; 100(5): 1276 - 1282.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovasc. Thorac. Ann.Home page
P. K. Neema, P. K. Sinha, and R. C. Rathod
Activated Clotting Time During Cardiopulmonary Bypass: Is Repetition Necessary During Open Heart Surgery?
Asian Cardiovasc Thorac Ann, March 1, 2004; 12(1): 47 - 52.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
P. J. Santrach
Devices for Monitoring Heparin and Protamine in the Operating Room
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2003; 7(4): 379 - 385.
[Abstract] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
W. C. Oliver Jr
Overview of Heparin and Protamine Management and Dosing Regimens in Pediatric Cardiac Surgical Patients
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2003; 7(4): 387 - 410.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
I. Shen, C. Giacomuzzi, and R. M. Ungerleider
Current strategies for optimizing the use of cardiopulmonary bypass in neonates and infants
Ann. Thorac. Surg., February 1, 2003; 75(2): S729 - S734.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
L. Shore-Lesserson
Monitoring the Hematologic Complications of Cardiopulmonary Bypass
Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 207 - 216.
[Abstract] [PDF]

Home page
 Anesth. Analg.Home page
R. Hansen, A. Koster, M. Kukucka, F. Mertzlufft, and H. Kuppe
A Quick Anti-Xa-Activity-Based Whole Blood Coagulation Assay for Monitoring Unfractionated Heparin During Cardiopulmonary Bypass: A Pilot Investigation
Anesth. Analg., September 1, 2000; 91(3): 533 - 538.
[Abstract] [Full Text] [PDF]

Home page
 PerfusionHome page
M. Codispoti and P. S Mankad
Management of anticoagulation and its reversal during paediatric cardiopulmonary bypass: a review of current UK practice
Perfusion, May 1, 2000; 15(3): 191 - 201.
[Abstract] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
A. S. Weisinger and J. H. Levy
Current Hematologic Issues in Cardiac Surgery and Cardiopulmonary Bypass
Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1998; 2(4): 259 - 271.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Bannan, A. Danby, D. Cowan, S. Ashraf, and P. G. Martin
Low Heparinization With Heparin-Bonded Bypass Circuits: Is It a Safe Strategy?
Ann. Thorac. Surg., March 1, 1997; 63(3): 663 - 668.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
S. O. Turner-Gomes, E. P. Nitschmann, G. R. Norman, M. E. Andrew, and W. G. Williams
Effect of Heparin Loading During Congenital Heart Operation on Thrombin Generation and Blood Loss
Ann. Thorac. Surg., February 1, 1997; 63(2): 482 - 488.
[Abstract] [Full Text]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
Y. J. Gu, R. J. Huyzen, and W. van Oeveren
INTRINSIC PATHWAY-DEPENDENT ACTIVATED CLOTTING TIME IS NOT RELIABLE FOR MONITORING ANTICOAGULATION DURING CARDIOPULMONARY BYPASS IN NEONATES
J. Thorac. Cardiovasc. Surg., March 1, 1996; 111(3): 677 - 678.
[Full Text]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
P. Martin, S. Bannan, and S. S. Ashraf
Individualized patient heparinization and protamine reversal
J. Thorac. Cardiovasc. Surg., February 1, 1996; 111(2): 493 - 493.
[Full Text]

Home page
 Ann. Thorac. Surg.Home page
K. Hashimoto, M. Yamagishi, T. Sasaki, M. Nakano, and H. Kurosawa
Heparin and antithrombin III levels during cardiopulmonary bypass: Correlation with subclinical plasma coagulation
Ann. Thorac. Surg., September 1, 1994; 58(3): 799 - 804.
[Abstract] [PDF]

Home page
 PerfusionHome page
A. G Hill, R. C Groom, B. F Akl, E. A Lefrak, and M. Kurusz
Current paediatric perfusion practice in North America
Perfusion, January 1, 1993; 8(1): 27 - 38.
[PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1992 by The Society of Thoracic Surgeons.