Comparison of short and prolonged ACT groups during cardiopulmonary bypass about postoperative drainage and blood transfusion

Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass About Postoperative Drainage and Blood Transfusion Berke Özkan, Dokuz Eylül Üniversitesi, Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İzmir. Objective: Coagulation cascade starts with any exangunation or any contact of blood with an extracorpareal surface (1,4,13,14,16). Since invention of heparin molecule in 1916, it has been an essential application for cardiopulmonary bypass (CPB). Nowadays during CPB we have been using Activated Clotting Time (ACT) test because it results quicker than other laboratory tests to evaluate anticoagulation of heparin (28,29,30,31,32). During CPB, high anticoagulation levels would result with unexpected high rate non-surgical bleeding. However lower anticoagulation doses would end up with high rate of tromboembolic events. Both situations can be related with high mortality or morbidity (48). There has been guidelines about blood conservation in cardiac surgery but clinical management of anticoagulation during CPB is not standartizated (47). In this respect, so far there has not been an ideal universal ACT value. Most clinics sets ACT target as above 400 - 480 seconds during CPB (41,42). Over the years most clinics apply 300 IU/kg dose heparin regimen which has been empirically advanced and universally accepted for CPB to reach target ACT values, but this regimen sometimes can lead to higher ACT values (48). This situation may cause to more postoperative bleeding, more postoperative blood transfusion and prolonged intensive care staying, although heparin is antagonized with protamine at the end of CPB. In this study we would like to compare retrospectively patients under went open heart surgery whom ACT's during CPB were 400-650 seconds with the patients whom ACT's were 650 seconds and higher during CPB. Materials and Method: In this study 192 patients under went CPB over age 18 between October 2014 and May 2014 retrospectively evaluated. Hospital operating system and archives were browsed, perfusion notes and intensive care unit notes were scanned, patient weight, operation made, body surface area, CPB time, aortic cross clamp time, gender, age, maximum ACT time during CPB, heparin dose managed, blood transfusion amount, postoperative first day dranige and intensive care duration has recorded. In this study, patients over age 18 under went CPB evaluated. Patients whom anticoagulation had started with 200 IU/kg heparin dose regimen with ACT range between 400 and 650 seconds during CPB represented as group I. 50 IU/kg additional heparin dose had been applied when ACT during CPB recorded below 400 seconds. Patients whom anticoagulation had started with 300 IU/kg heparin dose regimen with ACT range 650 seconds and higher during CPB represented as group II. Those two groups compared for postoperative first day drainage, postoperative blood transfusion amount and intensive care unit staying. Findings: No significant difference were found between two groups regarding ages (p=0,126), weights (p=0,526), body surface areas (p=0,762), CPB durations (p=0,415), aortic cross clamp times (p=0,387) are compared. There are statistical revealance between two groups for postoperative first day drainage (p=0,000), postoperative blood transfusion amount (p=0,000) and intensive care duration (p=0,0015) which favor for the group whom ACT range during CPB is 400-650 seconds. Result: In this study, patients during CPB with ACT range between 400 and 650 seconds favors for less postoperative first day drainage, postoperative blood transfusion and intensive care unit staying.