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Point of care management of heparin administration after heart surgery : A randomized, controlled trial

Merlani, Paolo ; Chenaud, Catherine ; Cottini, Silvia ; Reber, Guido ; Garnerin, Philippe ; de Moerloose, Philippe ; Ricou, Bara

In: Intensive Care Medicine, 2006, vol. 32, no. 9, p. 1357-1364

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    Titel
    • Point of care management of heparin administration after heart surgery
      A randomized, controlled trial
    Autor
    • Merlani, Paolo. Service of Surgical Intensive Care, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University of Geneva Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
    • Chenaud, Catherine. Service of Surgical Intensive Care, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University of Geneva Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
    • Cottini, Silvia. Service of Surgical Intensive Care, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University of Geneva Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
    • Reber, Guido. Service of Angiology and Hemostasis, Department of Medicine, University of Geneva Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
    • Garnerin, Philippe. Hospital Quality of Care Service and Service of Anesthesiology, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University of Geneva Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
    • de Moerloose, Philippe. Service of Angiology and Hemostasis, Department of Medicine, University of Geneva Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
    • Ricou, Bara. Service of Surgical Intensive Care, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University of Geneva Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Intensive Care Medicine, 2006, vol. 32, no. 9, p. 1357-1364. Springer-Verlag
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:319592
    Summary
    Objectives: Determination of activated partial thromboplastin time (aPTT) is used in coagulation management after heart surgery. Results from the central laboratory take long to be obtained. We sought to shorten the time to obtain coagulation results and the desired coagulation state and to reduce blood loss and transfusions using point of care (POC) aPTT determination. Design: Randomized, controlled trial. Setting: University-affiliated 20-bed surgical ICU. Patients and participants: Forty-two patients planned for valve surgery (Valves) and 84 for coronary artery bypass grafting (CABG) with cardiopulmonary bypass. Interventions: Valves and CABG were randomized to postoperative coagulation management monitored either by central laboratory aPTT (Lab group) or by POC aPTT (POC group). Heparin was administered according to guidelines. Measurements and results: POC aPTT results were available earlier than Lab aPTT after venipuncture in Valves (3 ± 2 vs. 125 ± 68 min) and in CABG (3 ± 4 vs. 114 ± 62 min). Heparin was introduced earlier in the POC group in Valves (7 ± 23 vs. 13 ± 78 h, p = 0.01). Valves of the POC group bled significantly less than Valves in the Lab group (647 ± 362 ml vs. 992 ± 647ml, p < 0.04), especially during the first 8 h after ICU admission. There was no difference in bleeding in CABG (1074 ± 869 ml vs. 1102 ± 620, p = NS). In Valves, fewer patients in the POC group than in the Lab group needed blood transfusions (1/21 vs. 8/21; p = 0.03). No difference was detected in CABG. Conclusions: In Valves in the POC group the time to the desired coagulation state was reduced, as was the thoracic blood loss, reducing the number of patients transfused. This improvement was not observed in CABG. Side effects were similar in the two groups