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Effects of heparin, haemodilution and aprotinin on kaolin‐based activated clotting time: in vitro comparison of two different point of care devices
Author(s) -
Dalbert S.,
Ganter M. T.,
Furrer L.,
Klaghofer R.,
Zollinger A.,
Hofer C. K.
Publication year - 2006
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2006.00990.x
Subject(s) - aprotinin , medicine , activated clotting time , cardiopulmonary bypass , cardiac surgery , heparin , anesthesia , antifibrinolytic , surgery , blood loss , tranexamic acid
Background: During cardiopulmonary bypass (CPB), measurement of kaolin‐based activated clotting time (kACT) is a standard practice in monitoring heparin‐induced anticoagulation. Despite the fact that the kACT test from the Sonoclot Analyzer ( S kACT) has been commercially available for several years, no published data on the performance of S kACT are available. Thus, the aim of this in vitro study was to compare S kACT with an established kACT from Hemochron ( H kACT). Methods: Blood was withdrawn from 25 patients before elective cardiac surgery. S kACT and H kACT were measured in duplicate after in vitro administration of heparin (0, 1, 2 and 3 U/ml), calcium‐free lactated Ringer's solution (25% and 50% haemodilution) and aprotinin (200 kIU/ml). Results: A total of 600 duplicate kACT measurements were obtained from 25 cardiac surgery patients. Overall, mean bias ± SD between S kACT and H kACT was 7 ± 70 s (1.3% ± 14.1%). Administration of heparin, haemodilution and aprotinin induced a comparable effect on both activated clotting time (ACT) tests. Mean bias ranged from −4 ± 39 s (−1.7% ± 12.9%) to 4 ± 78 s (3.2% ± 15.6%) for heparinzed blood samples after haemodilution or aprotinin application and increased after combined aprotinin administration and haemodilution. After haemodilution and administration of aprotinin, both ACT tests were less reliable for values >480 s in heparinized blood samples. Conclusion: Accuracy and performance of S kACT and H kACT were comparable after in vitro administration of heparin, aprotinin and haemodilution. Both ACT tests were considerably affected by aprotinin and haemodilution.