Detection of early incomplete heparin reversal following congenital cardiac surgery: A single-center retrospective observational study. Issue 182 (October 2019)

• Record Type: Journal Article
• Authors: Magunia, Harry; Schenk, Sebastian; Schlensak, Christian; Icheva, Vanya; Rosenberger, Peter; Straub, Andreas; Nowak-Machen, Martina
• Is Part Of: Thrombosis research. Issue 182(2019)
• Page Start: 33
• Page End: 38
• Publication Date: 2019-10
• Subjects: Congenital cardiac surgery -- Heparin -- Protamine -- Cardio-pulmonary bypass; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2019.08.008
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: The monitoring of unfractionated heparin (UFH) reversal with protamine plays a crucial role for bleeding management after cardio-pulmonary bypass (CPB) in congenital cardiac surgery. The current standard for the monitoring of UFH and its reversal is the activated clotting time (ACT). While the ACT is affected by other CPB-associated pathologies a bedside technique with more specific heparin-related results would be very helpful. The new point-of-care viscoelastic test Haemonetics TEG® 6s, which is based on small blood samples may fulfill these requirements. This study aimed to compare the new TEG with laboratory assays. Methods: A retrospective observational study was performed on 40 children with a median age of 130 days (interquartile range 13 to 310 days) undergoing congenital cardiac surgery. After separation of CPB, test results of the TEG® 6s, ACT, anti-Xa for UFH and PTT were compared and correlated with each other. Results: No clinically relevant correlation was found for heparin specific TEG-derived parameters (CK/CKH R-time ratio) with ACT, PTT and anti-Xa measurements. After grouping in dependence to the CK/CKH R-time in patients with and without successful heparin reversal again no significant difference of anti-Xa-UFH-levels, post-/pre-CPB ratio of the PTT and ACT was observed. Conclusions: In pediatric patients undergoing cardiac surgery using CPB there is no association of conventional coagulation tests and TEG-derived results. While bedside viscoelastic tests deliver rapid results, further studies are needed to compare whether the TEG based management of incomplete heparin reversal is sufficient to monitor heparin reversal and to reduce blood loss. Highlights: In pediatric cardiac surgery heparin reversal after CPB needs sufficient monitoring. Various conventional and bedside coagulation analyses may be used for this purpose. A new resonance-based thrombelastography assay may also be useful. Only weak correlation of conventional analyses and thrombelastography was found. The value of thrombelastography after heparin reversal needs further clarification.