PMID- 31445451
OWN - NLM
STAT- MEDLINE
DCOM- 20200427
LR  - 20200427
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 182
DP  - 2019 Oct
TI  - Detection of early incomplete heparin reversal following congenital cardiac 
      surgery: A single-center retrospective observational study.
PG  - 33-38
LID - S0049-3848(19)30338-X [pii]
LID - 10.1016/j.thromres.2019.08.008 [doi]
AB  - 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(R) 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(R) 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.
CI  - Copyright (c) 2019 Elsevier Ltd. All rights reserved.
FAU - Magunia, Harry
AU  - Magunia H
AD  - Department of Anesthesiology and Intensive Care Medicine, University Hospital 
      Tubingen, Eberhard-Karls-University Tubingen, Hoppe-Seyler-Str. 3, 72076 
      Tubingen, Germany. Electronic address: harry.magunia@med.uni-tuebingen.de.
FAU - Schenk, Sebastian
AU  - Schenk S
AD  - Department of Anesthesiology and Intensive Care Medicine, University Hospital 
      Tubingen, Eberhard-Karls-University Tubingen, Hoppe-Seyler-Str. 3, 72076 
      Tubingen, Germany.
FAU - Schlensak, Christian
AU  - Schlensak C
AD  - Department for Thoracic and Cardiovascular Surgery, University Hospital Tubingen, 
      Eberhard-Karls-University Tubingen, Hoppe-Seyler-Str. 3, 72076 Tubingen, Germany.
FAU - Icheva, Vanya
AU  - Icheva V
AD  - Department of Pediatric Cardiology, Intensive Care Medicine and Pulmonology, 
      University Hospital Tubingen, Eberhard-Karls-University Tubingen, 
      Hoppe-Seyler-Str. 1, 72076 Tubingen, Germany.
FAU - Rosenberger, Peter
AU  - Rosenberger P
AD  - Department of Anesthesiology and Intensive Care Medicine, University Hospital 
      Tubingen, Eberhard-Karls-University Tubingen, Hoppe-Seyler-Str. 3, 72076 
      Tubingen, Germany.
FAU - Straub, Andreas
AU  - Straub A
AD  - Department of Anesthesiology and Intensive Care Medicine, University Hospital 
      Tubingen, Eberhard-Karls-University Tubingen, Hoppe-Seyler-Str. 3, 72076 
      Tubingen, Germany.
FAU - Nowak-Machen, Martina
AU  - Nowak-Machen M
AD  - Department of Anesthesiology and Intensive Care Medicine, University Hospital 
      Tubingen, Eberhard-Karls-University Tubingen, Hoppe-Seyler-Str. 3, 72076 
      Tubingen, Germany.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20190818
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin Antagonists)
RN  - 0 (Protamines)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Blood Coagulation/drug effects
MH  - Blood Coagulation Tests
MH  - Cardiopulmonary Bypass/methods
MH  - Female
MH  - Heart Defects, Congenital/blood/*surgery
MH  - Heparin/*therapeutic use
MH  - Heparin Antagonists/*therapeutic use
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Protamines/*therapeutic use
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Cardio-pulmonary bypass
OT  - Congenital cardiac surgery
OT  - Heparin
OT  - Protamine
EDAT- 2019/08/25 06:00
MHDA- 2020/04/28 06:00
CRDT- 2019/08/25 06:00
PHST- 2019/06/26 00:00 [received]
PHST- 2019/08/09 00:00 [revised]
PHST- 2019/08/17 00:00 [accepted]
PHST- 2019/08/25 06:00 [pubmed]
PHST- 2020/04/28 06:00 [medline]
PHST- 2019/08/25 06:00 [entrez]
AID - S0049-3848(19)30338-X [pii]
AID - 10.1016/j.thromres.2019.08.008 [doi]
PST - ppublish
SO  - Thromb Res. 2019 Oct;182:33-38. doi: 10.1016/j.thromres.2019.08.008. Epub 2019 
      Aug 18.