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Ann Thorac Surg 1996;61:781-782
© 1996 The Society of Thoracic Surgeons

Editorials

Monitoring of Systemic Anticoagulation During Cardiopulmonary Bypass

Benjamin P. Bidstrup, FRACS

North Queensland Clinical School, University of Queensland, Townsville, Australia

The first 20% of the full text of this article appears below.

The activated/automated clotting time (ACT) is familiar to surgeons, anesthetists, and perfusionists. In one form or another, it is used to monitor the presence (and adequacy) of anticoagulation during cardiopulmonary bypass. Since the reports by Bull and associates [1–3], there have been few studies to determine the correct level for the ACT. Minimum times acceptable in many practices range from 300 to 480 seconds. Despite heparin regimens in current use, there is biochemical evidence of thrombin generation (indicating activation of clotting cascade) [4, 5] and increased fibrinolytic activity. This can be measured with markers such as thrombin-antithrombin III complex, prothrombin fragment 1.2, and fibrinopeptide A. The heparin doses used in these studies are then unable to prevent the intrinsic pathway (due to contact with foreign surfaces) and the extrinsic pathway (via tissue factor) from some degree of activation. In addition, other pathways lead to activation of the remainder of the plasma . . . [Full Text of this Article]


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Response of Kaolin ACT to Heparin: Evaluation With an Automated Assay and Higher Heparin Doses
George J. Despotis, Alexander L. Alsoufiev, Edward Spitznagel, Lawrence T. Goodnough, and Demetrios G. Lappas
Ann. Thorac. Surg. 1996 61: 795-799. [Abstract] [Full Text]





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