Thorac Cardiovasc Surg 2016; 64(06): 494-500
DOI: 10.1055/s-0035-1570035
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Antifactor Xa Activity for the Management of Anticoagulation during Cardiac Surgery

Christian Reyher
1  Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
,
Claire Würfel
1  Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
,
Edelgard Lindhoff-Last
2  Division of Hemostaseology, Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
3  Cardioangiology Center Bethanien (CCB), CCB Coagulation Research Center, Frankfurt, Germany
,
Patrick Meybohm
1  Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
,
Kai Zacharowski
1  Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
,
Anton Moritz
4  Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
,
Marc Schindewolf*
2  Division of Hemostaseology, Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
5  Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland
,
Christian Friedrich Weber*
1  Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
› Author Affiliations
Further Information

Publication History

31 July 2015

28 October 2015

Publication Date:
12 January 2016 (online)

Abstract

Background In patients with autoimmune diseases associated with antiphospholipid antibodies, precise management of anticoagulation during extracorporeal circulation (ECC) is complicated. It was the aim of the present study to determine whether antifactor Xa (aXa) activity is useful in guiding heparin therapy during ECC.

Methods In 15 patients undergoing cardiac surgery, anticoagulation with unfractionated heparin (UFH) and its reversal with protamine were guided using activated clotting time (ACT) (>400 second during ECC; ≤100 second for UFH reversal). For each ACT, the corresponding aXa activity levels were measured.

Results A total of 144 blood samples were obtained. ACT and aXa activity were significantly correlated (r = 0.771, p< 0.0001, Spearman rank-order correlation). Using receiver operating characteristic curve (ROC) analyses, the cutoffvalues for aXa activity were 1.14 IU/mL (area under the ROC curve [AUC]: 0.89; inaccuracy rate: 9.4%) to predict ACT > 400 seconds and 0.55 IU/mL (AUC: 0.85; inaccuracy rate: 13.3%) for ACT ≤ 100 seconds.

Conclusion AXa activity is strongly correlated with ACT, and therefore may be feasible for managing anticoagulation with UFH during ECC.

* Both the Authors Contributed Equally to this Work.