Anticoagulation monitoring during extracorporeal circulation with the Hepcon/HMS device

• Published in: Perfusion 2012-05, Vol.27 (3), p.214-220
• Main Authors: Noui, N, Zogheib, E, Walczak, K, Werbrouck, A, Amar, A Ben, Dupont, H, Caus, T, Remadi, JP
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Anticoagulants - pharmacokinetics; Aortic Valve - surgery; Coronary Artery Bypass; Extracorporeal Circulation; Hemorrhage - blood; Hemorrhage - therapy; Heparin - administration & dosage; Heparin - pharmacokinetics; Humans; Male; Monitoring, Physiologic - instrumentation; Monitoring, Physiologic - methods; Postoperative Period; Protamines - blood; Time Factors
• ISSN: 0267-6591; 1477-111X
• DOI: 10.1177/0267659112436632

Objective: The objective of our study was to compare the standard protocol of anticoagulation to the Hepcon/HMS. Method: This study included forty-four patients who underwent coronary bypass grafting surgery (CABG), or biological aortic valve replacement (AVR). Unfractionated heparin (UH) was used for patients who underwent operations in the control group (n = 22) (300U/Kg of UH with a goal of an ACT of 400s). The heparin was antagonized dose/dose by protamine. For the patients who underwent operations in the HMS group (n = 22), the heparin and protamine doses were assessed by the Hepcon/HMS device. Results: The sex ratio amounted to 1.93 (29 men and 15 women) and the mean age was 70 ± 11 years. The patients in the HMS group had a chest closure time that was significantly shorter than patients in the control group. The times were, respectively, 42 ± 15 minutes and 68 ± 27 minutes (p = 0.001). The protamine/heparin ratio was significantly lower in the HMS group (0.62 ± 0.13 vs. 1 ± 0.11) (p = 0.0001). The postoperative bleeding amounted to 804 ± 729 ml in the HMS group versus 1416 ± 1103 in the control group (p = 0.016). In multivariate linear regression analysis, only two independent factors were significantly associated with bleeding: the Hepcon/HMS (OR = 0.1-p = 0.03) and the preoperative hemoglobin rate (OR = 1.4 - p = 0.05). Postoperatively, within 72 hours, the red blood cell transfusion was 1.04 ± 1.5 units for the HMS group and 2.1 ± 1.87 units for the control group (p = 0.05). Conclusion: During cardiac surgery under CPB, heparin and protamine titration with the Hepcon/HMS device could predict a lower protamine dose and lower postoperative bleeding without higher thromboembolic events, and lower perioperative red blood cell transfusion with a shorter chest closure time.