A Blinded Randomized Trial Comparing Standard Activated Clotting Time Heparin Management to High Target Active Clotting Time and Individualized Hepcon HMS Heparin Management in Cardiopulmonary Bypass Cardiac Surgical Patients.

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic and Cardiovascular Surgery Pub Date : 2022-06-20 Epub Date: 2021-12-22 DOI:10.5761/atcs.oa.21-00222
Gregory A Nuttall, Mark M Smith, Bradford B Smith, Jon M Christensen, Paula J Santrach, Hartzell V Schaff
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引用次数: 2

Abstract

Purpose: High-dose heparin has been suggested to reduce consumption coagulopathy.

Materials and methods: In a randomized, blinded, prospective trial of patients undergoing elective, complex cardiac surgery with cardiopulmonary bypass, patients were randomized to one of three groups: 1) high-dose heparin (HH) receiving an initial heparin dose of 450 u/kg, 2) heparin concentration monitoring (HC) with Hepcon Hemostasis Management System (HMS; Medtronic, Minneapolis, MN, USA) monitoring, or 3) a control group (C) receiving a standard heparin dose of 300 u/kg. Primary outcome measures were blood loss and transfusion requirements.

Results: There were 269 patients block randomized based on primary versus redo sternotomy to one of the three groups from August 2001 to August 2003. There was no difference in operative bleeding between the groups. Chest tube drainage did not differ between treatment groups at 8 hours (median [25th percentile, 75th percentile] for control group was 321 [211, 490] compared to 340 [210, 443] and 327 [250, 545], p = 0.998 and p = 0.540, for HH and HC treatment groups, respectively). The percentage of patients receiving transfusion was not different among the groups.

Conclusion: Higher heparin dosing accomplished by either activated clot time or HC monitoring did not reduce 24-hour intensive care unit blood loss or transfusion requirements.

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一项比较体外循环心脏手术患者标准活化凝血时间肝素管理与高目标活化凝血时间和个体化Hepcon HMS肝素管理的随机盲法试验。
目的:大剂量肝素已被建议用于减少消耗性凝血病。材料与方法:在一项随机、盲法、前瞻性试验中,接受选择性复杂心脏手术合并体外循环的患者,患者被随机分为三组:1)高剂量肝素(HH),初始肝素剂量为450 u/kg, 2)肝素浓度监测(HC)使用Hepcon止血管理系统(HMS);Medtronic, Minneapolis, MN, USA)监测,或3)对照组(C)接受300u /kg标准肝素剂量。主要结局指标为失血量和输血需求。结果:2001年8月至2003年8月,269例患者根据首次胸骨切开术和再次胸骨切开术进行分组随机。两组手术出血无明显差异。治疗组间8小时胸管引流无差异(对照组[25、75百分位数]中位数为321[211、490],HH组为340[210、443],HC组为327[250、545],p = 0.998和p = 0.540)。两组患者接受输血的比例没有差异。结论:通过活化凝块时间或HC监测实现的高肝素剂量并没有减少24小时重症监护病房的出血量或输血需求。
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来源期刊
Annals of Thoracic and Cardiovascular Surgery
Annals of Thoracic and Cardiovascular Surgery CARDIAC & CARDIOVASCULAR SYSTEMS-SURGERY
CiteScore
2.80
自引率
0.00%
发文量
56
审稿时长
4-8 weeks
期刊介绍: Information not localized
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