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DOI: 10.1160/TH07-04-0307
Monitoring high-dose heparinization during cardiopulmonary bypass – A comparison between prothrombinase-induced clotting time (PiCT) and two chromogenic anti-factor Xa activity assays
Financial support: This work was supported in part by Finnish governmental special grants for health sciences research (Helsinki University Central Hospital) and research grants from the Finnish Angiology Society, the Research Foundation of Orion Corporation, and the Finnish Medical Foundation.Publication History
Received: 26 April 2007
Accepted after major revision: 11 January 2007
Publication Date:
24 November 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/200802/lookinside/thumbnails/10-1160-th07-04-0307-1.jpg)
Summary
Heparinization requires monitoring, but optimal methods for measuring the anticoagulant effects of heparin remain to be determined. We compared prothrombinase-induced clotting time (PiCT) and two chromogenic anti-factor Xa activity (anti-Xa) assays in monitoring high-dose heparinization during cardiopulmonary by-pass (CPB). Heparin effects were serially measured with PiCT and two anti-Xa assays in 100 patients. Antithrombin and protein C activities were measured preoperatively, and antithrombin activity was measured during CPB. Activation of coagulation was assessed with measurements of prothrombin fragment F1+2, soluble fibrin complexes, and D-dimer before, during, and after CPB. During CPB mean ranges of PiCT and of anti-Xa heparin levels measured with (anti-Xa A) and without (anti-Xa B) dextran sulfate and antithrombin supplementation were 5.0–5.2, 4.7–5.0, and 4.5–4.9 IU/ml, respectively. There was poor agreement between PiCT and anti-Xa and between the two anti-Xa assays (r=0.32–0.65 and broad limits of agreement). Patients with low preoperative antithrombin or protein C levels had lower PiCT (p=0.028 and p=0.01) and anti-Xa A (both p<0.001) levels during CPB than others. Patients with the lowest heparin activities during CPB (lowest deciles of PiCT and anti-Xa A) had higher subsequent F1+2 after CPB (p=0.002 and p=0.02), and patients with high heparin levels required fewer transfusions of packed red blood cells than others. In conclusion, in the challenging setting of CPB there is poor agreement between anti-Xa assays and PiCT. However, coagulation-based PiCT could provide an alternative to the chromogenic anti-Xa assays. Higher heparin levels during CPB were confirmed to associate with reduced transfusion requirements.
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