This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): J. Andreas Hoschtitzky Andrew Ronald Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aziz, K. A. A. Articles by Ronald, A. Search for Related Content PubMed PubMed Citation Articles by Aziz, K. A. A. Articles by Ronald, A. Related Collections Anesthesia Cardiac - other Education

Does use of the Hepcon^® point-of-care coagulation monitor to optimise heparin and protamine dosage for cardiopulmonary bypass decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery?

^a Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
^b Department of Anaesthesia, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK

*Corresponding author. Tel.: +44 1224 553237; fax: +44 1224 554483.

E-mail address: alronald{at}tiscali.co.uk (A. Ronald).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether use of the Hepcon^® point-of-care coagulation monitor (Medtronic, Minneapolis, MN) to optimise and monitor heparin and protamine dosage for cardiopulmonary bypass could decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery. Altogether 680 papers were identified on Medline, and 879 on Embase using the reported search strategy. Two further relevant papers were found by hand-searching of reference lists. Fourteen papers represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that in patients undergoing cardiac surgery, use of the Hepcon^® coagulation monitor will increase the dose of heparin but decrease the dose of protamine administered compared to more empirical ACT-based dosing regimes. There is some evidence that this leads to less activation of the coagulation system and may be associated with decreased postoperative bleeding and blood product requirements but more work is required to quantify the magnitude of this effect.

Key Words: Cardiac surgery; Cardiopulmonary bypass; Coagulation management; Heparin; Protamine; Blood products

This article has been cited by other articles:

				J. Dunning, M. Versteegh, A. Fabbri, A. Pavie, P. Kolh, U. Lockowandt, S. A.M. Nashef, and on behalf of the EACTS Audit and Guidelines Commit Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 73 - 92. [Abstract] [Full Text] [PDF]