Max Hoebink, Thomas A H Steunenberg, Liliane C Roosendaal, Arno M Wiersema, Henrike M Hamer, Kak Khee Yeung, Vincent Jongkind
{"title":"Ability of Activated Clotting Time Measurements to Monitor Unfractionated Heparin Activity During NonCardiac Arterial Procedures.","authors":"Max Hoebink, Thomas A H Steunenberg, Liliane C Roosendaal, Arno M Wiersema, Henrike M Hamer, Kak Khee Yeung, Vincent Jongkind","doi":"10.1016/j.avsg.2024.10.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Activated clotting time (ACT) measurements are frequently used to monitor unfractionated heparin activity during noncardiac arterial procedures (NCAP). Accuracy of ACT-guided heparinization is mandatory to prevent heparin under and overdosing, thereby minimizing thrombo-embolic complications (TECs) and bleeding risk. The main objective of this study was to investigate accuracy of ACT to monitor heparin activity during NCAP using the Hemostasis Management System Plus (HMS) with high-range (HR) cartridges. ACT values were compared with anti-Xa measurements, regarded as the standard test to measure active heparin.</p><p><strong>Methods: </strong>This was a single-center, prospective, observational cohort study. Perioperative blood samples of patients undergoing NCAP between December 2022 and September 2023 were used to perform bedside ACT measurements and anti-Xa assays in the clinical laboratory. Primary outcome was the association between ACT and anti-Xa measurements. TEC, mortality, and bleeding complications within 30 days postoperatively or during primary admission were also scored.</p><p><strong>Results: </strong>196 pairs of ACT and anti-Xa measurements were performed in 34 patients. Strong correlation was observed between anti-Xa and ACT measurements (Pearson's correlation coefficient = 0.84, 95% CI = 0.79-0.87, P < 0.001). Apart from anti-Xa, no additional variables were associated with ACT in multivariate linear regression analyses (regression coefficient β = 36.7, 95% CI = 33.3-40.1, P < 0.001). Bleeding complications occurred in 29% of the patients, while both TEC and mortality were observed in one patient.</p><p><strong>Conclusions: </strong>Strong correlation and an independent association were observed between heparin activity measured by anti-Xa and ACT using the HMS Plus.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":"460-468"},"PeriodicalIF":1.4000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.avsg.2024.10.003","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/17 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Activated clotting time (ACT) measurements are frequently used to monitor unfractionated heparin activity during noncardiac arterial procedures (NCAP). Accuracy of ACT-guided heparinization is mandatory to prevent heparin under and overdosing, thereby minimizing thrombo-embolic complications (TECs) and bleeding risk. The main objective of this study was to investigate accuracy of ACT to monitor heparin activity during NCAP using the Hemostasis Management System Plus (HMS) with high-range (HR) cartridges. ACT values were compared with anti-Xa measurements, regarded as the standard test to measure active heparin.
Methods: This was a single-center, prospective, observational cohort study. Perioperative blood samples of patients undergoing NCAP between December 2022 and September 2023 were used to perform bedside ACT measurements and anti-Xa assays in the clinical laboratory. Primary outcome was the association between ACT and anti-Xa measurements. TEC, mortality, and bleeding complications within 30 days postoperatively or during primary admission were also scored.
Results: 196 pairs of ACT and anti-Xa measurements were performed in 34 patients. Strong correlation was observed between anti-Xa and ACT measurements (Pearson's correlation coefficient = 0.84, 95% CI = 0.79-0.87, P < 0.001). Apart from anti-Xa, no additional variables were associated with ACT in multivariate linear regression analyses (regression coefficient β = 36.7, 95% CI = 33.3-40.1, P < 0.001). Bleeding complications occurred in 29% of the patients, while both TEC and mortality were observed in one patient.
Conclusions: Strong correlation and an independent association were observed between heparin activity measured by anti-Xa and ACT using the HMS Plus.
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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