PMID- 36100498
OWN - NLM
STAT- MEDLINE
DCOM- 20221115
LR  - 20230223
IS  - 1532-8422 (Electronic)
IS  - 1053-0770 (Linking)
VI  - 36
IP  - 12
DP  - 2022 Dec
TI  - A Pilot Study to Assess the Clinical Onset of IV Heparin in Interventional 
      Cardiology and Cardiac Surgery.
PG  - 4281-4288
LID - S1053-0770(22)00546-8 [pii]
LID - 10.1053/j.jvca.2022.07.030 [doi]
AB  - OBJECTIVES: To determine the onset of heparin anticoagulation, using 2 different 
      measures of activated clotting times (ACT), thromboelastography (TEG; R-time), 
      and anti-Xa levels, after administering low- (100 U/kg) and high- (300 U/kg) dose 
      intravenous (IV) heparin to patients undergoing transcatheter aortic valve 
      replacement (TAVR) and cardiac surgery, respectively. DESIGN: Prospective study. 
      SETTING: Single academic institution. PARTICIPANTS: Patients with normal baseline 
      coagulation presenting for TAVR or cardiac valve surgery. INTERVENTIONS: 
      Coagulation studies were performed at baseline, 30 seconds, 90 seconds, and 180 
      seconds after IV heparin administration. The tests included iSTAT (iACT) and 
      Hemochron ACT (hACT), TEG R-Time, and anti-Xa levels. At the authors' 
      institution, anti-Xa is the preferred measure of heparin anticoagulation when 
      time permits. ACT, a rapid point- of-care test, is used to assess intraprocedural 
      anticoagulation. MEASUREMENTS AND MAIN RESULTS: After both low- and high-dose 
      heparin, there are peak increases in ACT and anti-Xa at 30 seconds, followed by a 
      decline at 90 seconds and plateau at 180 seconds. The TEG R-time remained 
      elevated (>80 minutes) throughout. For TAVR cases, all anti-Xa was >1.5 IU/mL, 
      and was associated with an iACT >180 seconds and an hACT >200 seconds. For 
      cardiac valve surgery cases, all anti-Xa was >2.4 and associated with an iACT 
      >420 seconds and and hACT >340 seconds. Compared with hACT, iACTs were 
      significantly lower at all time points after low-dose heparin, but not after 
      high-dose heparin. CONCLUSIONS: In this pilot study, heparin anticoagulation was 
      detected as early as 30 seconds after IV administration, based on ACT, anti-Xa 
      levels, and TEG R-time.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Asher, Shyamal
AU  - Asher S
AD  - Department of Anesthesiology, Rhode Island Hospital, Providence, RI. Electronic 
      address: ashershy@gmail.com.
FAU - Maslow, Andrew
AU  - Maslow A
AD  - Department of Anesthesiology, Rhode Island Hospital, Providence, RI.
FAU - Mishra, Vikas
AU  - Mishra V
AD  - Department of Anesthesiology, Rhode Island Hospital, Providence, RI.
FAU - Flaherty, Devon
AU  - Flaherty D
AD  - Department of Anesthesiology, Rhode Island Hospital, Providence, RI.
FAU - Hayward, Geoffrey
AU  - Hayward G
AD  - Department of Anesthesiology, Rhode Island Hospital, Providence, RI.
FAU - Whiteneck, Stephanie
AU  - Whiteneck S
AD  - Department of Hematology, Rhode Island Hospital, Providence, RI.
FAU - Cheves, Tracey
AU  - Cheves T
AD  - Department of Hematology, Rhode Island Hospital, Providence, RI.
FAU - Sweeney, Joseph
AU  - Sweeney J
AD  - Department of Hematology, Rhode Island Hospital, Providence, RI.
LA  - eng
PT  - Journal Article
DEP - 20220805
PL  - United States
TA  - J Cardiothorac Vasc Anesth
JT  - Journal of cardiothoracic and vascular anesthesia
JID - 9110208
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Humans
MH  - Pilot Projects
MH  - Anticoagulants
MH  - Prospective Studies
MH  - Heparin
MH  - *Cardiac Surgical Procedures
MH  - *Cardiology
MH  - Whole Blood Coagulation Time
EDAT- 2022/09/14 06:00
MHDA- 2022/11/16 06:00
CRDT- 2022/09/13 22:04
PHST- 2022/04/20 00:00 [received]
PHST- 2022/07/27 00:00 [revised]
PHST- 2022/07/29 00:00 [accepted]
PHST- 2022/09/14 06:00 [pubmed]
PHST- 2022/11/16 06:00 [medline]
PHST- 2022/09/13 22:04 [entrez]
AID - S1053-0770(22)00546-8 [pii]
AID - 10.1053/j.jvca.2022.07.030 [doi]
PST - ppublish
SO  - J Cardiothorac Vasc Anesth. 2022 Dec;36(12):4281-4288. doi: 
      10.1053/j.jvca.2022.07.030. Epub 2022 Aug 5.