PMID- 29481926
OWN - NLM
STAT- MEDLINE
DCOM- 20181023
LR  - 20181023
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 50
DP  - 2018 Jul
TI  - Anticoagulation Obtained below the Arterial Clamp Using a Single Fixed Bolus of 
      Heparin in Vascular Surgery: A Pilot Study.
PG  - 242-248
LID - S0890-5096(18)30162-6 [pii]
LID - 10.1016/j.avsg.2017.11.060 [doi]
AB  - BACKGROUND: No clear recommendations exist regarding the optimal dosing of 
      unfractionated heparin (UFH) during vascular surgery. Moreover, little is known 
      about the effect of the UFH bolus downstream of the arterial clamp, where stasis 
      and inflammation can possibly alter the anticoagulation obtained. METHODS: The 
      aim of our prospective observational study was to assess anticoagulation below 
      the arterial clamp and its clinical impact on the quality of revascularization. 
      Thirty-six patients American Society of Anaesthesiologists physical status (ASA) 
      grade I-III undergoing open revascularization surgeries were included. A baseline 
      activated coagulation time (ACT) was obtained. Thirty minutes after a single 
      bolus of 5,000 units of UFH, we measured an upstream ACT via a radial arterial 
      catheter and an ACT below the arterial clamp via surgeon sampling. The quality of 
      revascularization was assessed with preoperative and postoperative ankle-brachial 
      and toe-brachial indexes (TBIs). RESULTS: The upstream postheparin ACT was 
      significantly higher than the downstream postheparin ACT, with a mean difference 
      of 24.3 sec (P < 0.0001). In 7 patients, the downstream ACT was lower than the 
      baseline ACT. The upstream and downstream heparin concentrations were similar. 
      There was no relationship between the downstream ACT and either ankle-brachial 
      index improvement (28 patients, P = 0.51) or TBI improvement (27 patients, 
      P = 0.21). CONCLUSIONS: Our study demonstrates a significant difference between 
      the ACT above and below the arterial clamp without any clinical impact of this 
      possibly insufficient anticoagulation. Further investigations are warranted to 
      determine the optimal dose of UFH in vascular surgery. TRIAL REGISTRATION: 
      Clinicaltrials.gov, NCT02477072.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Roy, Maxim
AU  - Roy M
AD  - Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Canada. 
      Electronic address: maxim.roy20@gmail.com.
FAU - Todorov, Alexandre
AU  - Todorov A
AD  - Washington University in St. Louis (WUSTL), St-Louis, USA.
FAU - Ruel, Monique
AU  - Ruel M
AD  - Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Canada.
FAU - Elkouri, Stephane
AU  - Elkouri S
AD  - Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Canada.
FAU - Hardy, Jean-Francois
AU  - Hardy JF
AD  - Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Canada.
LA  - eng
SI  - ClinicalTrials.gov/NCT02477072
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
DEP - 20180223
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Ankle Brachial Index
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Constriction
MH  - Female
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Intraoperative/methods
MH  - Peripheral Arterial Disease/blood/diagnosis/*surgery
MH  - Pilot Projects
MH  - Prospective Studies
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/adverse effects/instrumentation/*methods
MH  - Whole Blood Coagulation Time
EDAT- 2018/02/27 06:00
MHDA- 2018/10/24 06:00
CRDT- 2018/02/27 06:00
PHST- 2017/07/03 00:00 [received]
PHST- 2017/10/17 00:00 [revised]
PHST- 2017/11/12 00:00 [accepted]
PHST- 2018/02/27 06:00 [pubmed]
PHST- 2018/10/24 06:00 [medline]
PHST- 2018/02/27 06:00 [entrez]
AID - S0890-5096(18)30162-6 [pii]
AID - 10.1016/j.avsg.2017.11.060 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2018 Jul;50:242-248. doi: 10.1016/j.avsg.2017.11.060. Epub 2018 
      Feb 23.