• J. Cardiothorac. Vasc. Anesth. · Nov 2020

    Evaluation of Point-of-Care ACT Coagulometers and Anti-Xa Activity During Cardiopulmonary Bypass.

    • Florian Falter, Stephen MacDonald, Claire Matthews, Evelien Kemna, José Cañameres, and Martin Besser.
    • Department of Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK. Electronic address: florian.falter@gmail.com.
    • J. Cardiothorac. Vasc. Anesth. 2020 Nov 1; 34 (11): 2921-2927.

    ObjectiveThe activated clotting time (ACT) is used worldwide to confirm safe heparin anticoagulation for cardiopulmonary bypass. For the present study, the performances of 2 commonly used ACT devices were compared with each other and with anti-Xa levels throughout the surgical procedure in order to understand whether they can be used interchangeably.DesignProspective study.SettingTertiary care center.ParticipantsThe study comprised 33 elective adult cardiac surgical patients.InterventionsBlood samples were taken at standard times throughout the surgery (after induction, after heparin bolus, 4 samples at 30-minute intervals during cardiopulmonary bypass, after protamine), and ACTs and anti-Xa levels were analyzed. Data were compared using receiver operating characteristics and LOESS regression.Measurements And Main ResultsThe correlation between anti-Xa levels and the Hemochron ACT (Instrumentation Laboratory, Bedford, MA) was acceptable (r = 0.82, 95% confidence interval [CI] 0.757-0.868; p < 0.0001), as was the correlation between anti-Xa levels and the i-STAT (Abbott Point of Care, Abbott Park, IL) (r = 0.81, 95% CI 0.738-0.858; p < 0.0001). The correlation between the 2 ACT methods was poorer (r = 0.77, 95% CI 0.707-0.828; p < 0.0001) than their correlation to anti-Xa levels. When compared with anti-Xa levels, the sensitivity and specificity were mediocre for both devices, although the i-STAT performed better than the Hemochron ACT. The Hemochron ACT read higher values than the i-STAT ACT throughout the course of the surgery.ConclusionThe correlation between the Hemochron ACT and i-STAT ACT is moderate, and they have different sensitivity and specificity when compared with anti-Xa levels. This suggests that ACT devices should not be used interchangeably, but cut-off values for safe anticoagulation during cardiopulmonary bypass should be determined for each type of device, particularly when switching supplier.Copyright © 2020 Elsevier Inc. All rights reserved.

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