PDF herunterladen
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
› Institutsangaben
Weitere Informationen

Publikationsverlauf

31. Juli 2015

28. Oktober 2015

Publikationsdatum:
12. Januar 2016 (online)

    Lizenzen und Reprints Alle Artikel dieser Rubrik

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.

Keywords

activated clotting time - antifactor Xa - unfractionated heparin - cardiac surgery - extracorporeal circulation

* Both the Authors Contributed Equally to this Work.


 

  • References

  • 1 Gómez-Puerta JA, Cervera R. Diagnosis and classification of the antiphospholipid syndrome. J Autoimmun 2014; 48–49: 20-25
    PubMedGoogle Scholar
  • 2 Shapiro SS, Thiagarajan P. Lupus anticoagulants. ProgHemostThromb 1982; 6: 263-285
    PubMedGoogle Scholar
  • 3 Djokovic A, Stojanovich L, Kontic M, Stanisavljevic N, Radovanovic S, Marisavljevic D. Association between cardiac manifestations and antiphospholipid antibody type and level in a cohort of Serbian patients with primary and secondary antiphospholipid syndrome. Isr Med Assoc J 2014; 16 (3) 162-167
    PubMedGoogle Scholar
  • 4 Zuily S, Huttin O, Mohamed S, Marie PY, Selton-Suty C, Wahl D. Valvular heart disease in antiphospholipid syndrome. CurrRheumatol Rep 2013; 15 (4) 320
    PubMedGoogle Scholar
  • 5 Erdozain JG, Ruiz-Irastorza G, Segura MI , et al. Cardiac valve replacement in patients with antiphospholipid syndrome. Arthritis Care Res (Hoboken) 2012; 64 (8) 1256-1260
    PubMedGoogle Scholar
  • 6 Berkun Y, Elami A, Meir K, Mevorach D, Naparstek Y. Increased morbidity and mortality in patients with antiphospholipid syndrome undergoing valve replacement surgery. J ThoracCardiovascSurg 2004; 127 (2) 414-420
    PubMedGoogle Scholar
  • 7 Gorki H, Malinovski V, Stanbridge RD. The antiphospholipid syndrome and heart valve surgery. Eur J CardiothoracSurg 2008; 33 (2) 168-181
    PubMedGoogle Scholar
  • 8 Bembea MM, Annich G, Rycus P, Oldenburg G, Berkowitz I, Pronovost P. Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: an international survey. PediatrCrit Care Med 2013; 14 (2) e77-e84
    PubMedGoogle Scholar
  • 9 Palmer K, Ridgway T, Al-Rawi O, Poullis M. Heparin therapy during extracorporeal circulation: deriving an optimal activated clotting time during cardiopulmonary bypass for isolated coronary artery bypass grafting. J Extra CorporTechnol 2012; 44 (3) 145-150
    PubMedGoogle Scholar
  • 10 Mehta TP, Smythe MA, Mattson JC. Strategies for managing heparin therapy in patients with antiphospholipid antibody syndrome. Pharmacotherapy 2011; 31 (12) 1221-1231
    CrossrefPubMedGoogle Scholar
  • 11 East CJ, Clements F, Mathew J, Slaughter TF. Antiphospholipid syndrome and cardiac surgery: management of anticoagulation in two patients. AnesthAnalg 2000; 90 (5) 1098-1101
    PubMedGoogle Scholar
  • 12 Dornan RI. Acute postoperative biventricular failure associated with antiphospholipid antibody syndrome. Br J Anaesth 2004; 92 (5) 748-754
    CrossrefPubMedGoogle Scholar
  • 13 Fitch JC, Geary KL, Mirto GP, Byrne DW, Hines RL. Heparin management test versus activated coagulation time during cardiovascular surgery: correlation with anti-Xa activity. J CardiothoracVascAnesth 1999; 13 (1) 53-57
    PubMedGoogle Scholar
  • 14 Hellstern P, Bach J, Simon M, Saggau W. Heparin monitoring during cardiopulmonary bypass surgery using the one-step point-of-care whole blood anti-factor-Xa clotting assay heptest-POC-Hi. J Extra CorporTechnol 2007; 39 (2) 81-86
    PubMedGoogle Scholar
  • 15 Koster A, Despotis G, Gruendel M , et al. The plasma supplemented modified activated clotting time for monitoring of heparinization during cardiopulmonary bypass: a pilot investigation. AnesthAnalg 2002; 95 (1) 26-30
    PubMedGoogle Scholar
  • 16 Pappalardo F, Franco A, Crescenzi G, De Simone F, Torracca L, Zangrillo A. Anticoagulation management in patients undergoing open heart surgery by activated clotting time and whole blood heparin concentration. Perfusion 2006; 21 (5) 285-290
    CrossrefPubMedGoogle Scholar
  • 17 Bull BS, Hay KL, Herrmann PC. Postoperative bypass bleeding: a bypass-associated dilutional (BAD) coagulopathy?. Blood Cells Mol Dis 2009; 43 (3) 256-259
    CrossrefPubMedGoogle Scholar
  • 18 Machin D, Devine P. The effect of temperature and aprotinin during cardiopulmonary bypass on three different methods of activated clotting time measurement. J Extra CorporTechnol 2005; 37 (3) 265-271
    PubMedGoogle Scholar
  • 19 De Waele JJ, Van Cauwenberghe S, Hoste E, Benoit D, Colardyn F. The use of the activated clotting time for monitoring heparin therapy in critically ill patients. Intensive Care Med 2003; 29 (2) 325-328
    CrossrefPubMedGoogle Scholar
  • 20 Despotis GJ, Levine V, Joist JH, Joiner-Maier D, Spitznagel E. Antithrombin III during cardiac surgery: effect on response of activated clotting time to heparin and relationship to markers of hemostatic activation. AnesthAnalg 1997; 85 (3) 498-506
    PubMedGoogle Scholar
  • 21 Koerber JM, Smythe MA, Begle RL, Mattson JC, Kershaw BP, Westley SJ. Correlation of activated clotting time and activated partial thromboplastin time to plasma heparin concentration. Pharmacotherapy 1999; 19 (8) 922-931
    CrossrefPubMedGoogle Scholar
  • 22 Haselbach S, Maurer J, Vogel V , et al. A novel method for the direct determination of heparin concentration during cardiopulmonary bypass surgery. ClinChem Lab Med 2013; 51 (10) 2037-2043
    PubMedGoogle Scholar
  • 23 Koniari I, Siminelakis SN, Baikoussis NG, Papadopoulos G, Goudevenos J, Apostolakis E. Antiphospholipid syndrome; its implication in cardiovascular diseases: a review. J CardiothoracSurg 2010; 5: 101
    PubMedGoogle Scholar
  • 24 Cho H, Jeon Y, Hong DM, Kim HJ, Min JJ. Anesthetic management of antiphospholipid syndrome patients who underwent cardiac surgery: three cases report. Korean J Anesthesiol 2014; 66 (2) 164-168
    CrossrefPubMedGoogle Scholar
  • 25 Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (3, Suppl): 188S-203S
    CrossrefPubMedGoogle Scholar
  • 26 Olson JD, Arkin CF, Brandt JT , et al. College of American Pathologists Conference XXXI on laboratory monitoring of anticoagulant therapy: laboratory monitoring of unfractionated heparin therapy. Arch Pathol Lab Med 1998; 122 (9) 782-798
    PubMedGoogle Scholar
  • 27 Junker R, Käse M, Schulte H, Bäumer R, Langer C, Nowak-Göttl U. Interferences in coagulation tests—evaluation of the 570-nm method on the Dade Behring BCS analyser. ClinChem Lab Med 2005; 43 (2) 244-252
    PubMedGoogle Scholar
  • 28 Nguyen T, Musick M, Teruya J. Anticoagulation monitoring during extracorporeal membrane oxygenation: is anti-factor Xa assay (heparin level) a better test?. PediatrCrit Care Med 2014; 15 (2) 178-179
    PubMedGoogle Scholar
  • 29 Artim-Esen B, Pericleous C, Mackie I , et al. Anti-factor Xa antibodies in patients with antiphospholipid syndrome and their effects upon coagulation assays. Arthritis Res Ther 2015; 17: 47
    CrossrefPubMedGoogle Scholar