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IMPACT OF APROTININ ON ACT AND HMT DURING CABG

Risch, A. MD; Mertzlufft, F. MD, PhD

doi: 10.1097/00000539-199802001-00095
Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Cardiovascular Anesthesia
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Klinik fur Anaesthesiologie und Intensivmedizin der Universitatskliniken, D-66421 Homburg, FRG.

Abstract S95

The ACT (activated clotting time: diatomaceous earth or Kaolin activator) is commonly used for monitoring heparinization during cardiac surgery. Antifibrinolytics (e.g. Aprotinin: Trasylol) are used to inhibit plasmin and kallikrein and to reduce blood loss and allogeneic transfusion requirements. However, measurement of ACT with the Hemochron procedure (surface activator Celit) comprises drawbacks due to e.g. hypothermia and Aprotinin (i.e. ACT prolongation of ca. 47 - 71% independent of the heparin level). With the advent of a new point-of-care device (TAS Analyzer; Cardiovascular Diagnostics Inc., Raleigh, NC) providing e.g. aPTT, PT, HMT and ECT [1] these problems could be eliminated. Therefore, the goal of the present study was to analyze the impact of Aprotinin on both the Hemochron Celit ACT and the new TAS Celit HMT during CABG.

METHODS: With approval of the local ethics comittee 40 patients scheduled for elective CABG participated (full dose heparinization: 300 U/kgBW). Randomly, they were allocated to group (I) {without Aprotinin: n = 20} or (II) {with Aprotinin: n = 20}, whereas antifibrinolytic therapy consisted of 500,000 KIE/h Trasylol (1000 KIE = 0.14 mg). Clotting time (sec) was monitored applying two Celit procedures: the established ACT (Hemochron; Int. Technidyne Corp., Edison, NJ) and the newly available heparin management test (HMT: TAS Analyzer; CVDI, Raleigh, NC). Samples were obtained prior (t1), immediately after (t2), and subsequently following (30 min intervals: t3 - t5) heparinization. Simultaneously, measurement of heparin concentration (Units/mL) was performed applying the cHep method (anti Xa procedure).

RESULTS: Results are shown in Table 1: without Trasylol (Table 1.I) and with Trasylol (Table 1.II); x +/- SD, U-test.

Table 1

Table 1

CONCLUSIONS: With respect to quoted advantages of noncelite ACT armamentarium (HemoTec Inc., Englewood, CO; Hemochron 8000, ITC, Edison, NJ) [2], the new celit point-of-care HMT analyzer (TAS, CVDI, Raleigh) provided reliable control of heparinization during CABG. Moreover, contrary to the Hemochron celit ACT, the accuracy of the TAS HMT values were not affected by the presence of Aprotinin.

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REFERENCES

1. Mertzlufft F, Risch A, Seyfert UT: Anaesthesist 1997; 46:233.
2. Wang JS, Lin CY, Hung WT, Karp RB: Anesthesiology 1992; 77:1080.
© 1998 International Anesthesia Research Society