ราชวิทยาลัยวิสัญญีแพทย์ แห่งประเทศไทย

The Royal College Of Anesthesiologists Of Thailand

  • CATEGORY
Initial dose of Heparin in Patient with Activated Clotting Time ≥ 150 seconds
Abstract
Background : Postoperative bleeding is one of the serious complications of cardiac surgery. Intravenous administration of heparin 300 units/kg may provide ACT ≥ 400 sec before cardiopulmonary bypass (CPB), especially in patients who have prolong activated clotting time (ACT). Objective : To evaluate the prebypass ACT value following intravenous heparin administration of 250 units/kg compare to 300 units/kg in cardiac patients undergoing coronary artery bypass graft (CABG) and/or valvular surgery with baseline ACT ≥ 150 sec Method : In this prospective randomized controlled study, 50 cardiac patients undergoing CABG/valvular surgery and baseline ACT ≥ 150 sec were randomly assigned to two groups of 25 patients. Each patient in group I and group II received heparin 250 units/kg and 300 units/kg respectively. Recheck ACT at 5 min following the first dose of heparin then at 60, 90, 120 and 150 min during CPB. If the ACT was less than or equal to 400 sec, additional heparin 100 units/kg was administered. Blood loss as well as blood and blood component replacement were recorded on the day of surgery and postoperative day one. Hematocrit, hemoglobin, platelet count, prothrombin time and activated partial thromboplastin time were obtained immediately on ICU arrival and at postoperative day one. Result : Both groups had prebypass ACT ≥ 400 sec. At 60 min on CPB, the ACTs were 441.4 ± 71.1 and 555.4 ± 122.58 sec (p = 0.001) in group I and group II respectively. There were no significant differences in the amount of postoperative blood loss and blood/blood component transfusion within 24 hours in both groups. The postoperative coagulogram and hemoglobin were within normal limit in both groups. Conclusion : These results suggest that in the patients who have preoperative ACT ≥ 150 sec, the initial dose of heparin 250 units/kg can produce prebypass ACT ≥ 400 sec. The postoperative blood loss and coagulogram are not significant difference in the both groups.