Background:
@EN High-dose aprotinin appears to enhance the anticoagulant effects of heparin, as documented by increases in the activated clotting times (ACTs) during cardiopulmonary bypass. This increase of the ACT in the presence of aprotinin and heprin is
due to
the use of celite as surface activator. We compared celite and kaolin as surface activators for the measurement of the ACT in cardiac surgical patients treated with high dose aprotinin.
@ES Methods:
@EN This study included 25 patients who scheduled for coronary bypass graft surgery and reoperation of cardiac valvular surgery. The 2 million units of aprotinin were added to the pump prime of heart-lung machine. The dosage of heparin and
protamine was
3mg/kg respectively. Whole blood was sampled 10 minutes after induction, heparin administration, cardiopulmonary bypass(CPB), 10 minutes before the termination of CPB and 10 minutes after protamine administration. The ACT was measured with
Hemochron 801
blood coagulation time with 12mg of either celite (C-ACT) or kaolin (K-ACT) used as surface activator.
@ES Results:
@EN At 10 minutes after induction and heparin administration, celite and kaolin ACTs were 120±28, 541±247 seconds and 126±23, 559±267 seconds respectively. But 10 minutes after initiation of CPB and before the termination of CPB, celite ACTs
were
941±238 and 787±277 seconds; kaolin ACTs were 605±182 and 499±65 seconds, which were consistently less than celite ACTs(p<0.01). At 10 minutes after protamine administration, celite ACT was 118±12 seconds and kaolin ACT was 142±56 seconds
which
was consistently more celite ACT(p<0.05).
@ES Conclusion:
@EN We recommend the K-ACT rather than C-ACT when monitoring of heparin-induced anticoagulation in patients treated with high-dose aprotinin, It is also highly recommended that patients being added with aprotinin should receive the usual doses of
heparin and that the ACT should be measured with kaolin as the activator.(Korean J Anesthesiol 1996; 30: 212~216)
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