Advertisement
Original article| Volume 7, ISSUE 4, P402-409, August 1993

Intraoperative measurement of activated partial thromboplastin time and prothrombin time by a portable laser photometer in patients following cardiopulmonary bypass

DOI:https://doi.org/10.1016/1053-0770(93)90160-M
Intraoperative measurement of activated partial thromboplastin time and prothrombin time by a portable laser photometer in patients following cardiopulmonary bypass
Previous ArticleChanges in left ventricular diameter during intravenous induction of anesthesia
Next ArticleComparison of thromboelastography to bleeding time and standard coagulation tests in patients after cardiopulmonary bypass
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Intraoperative capabilities to rapidly assess coagulation status following cardiopulmonary bypass (CPB) may be of benefit in providing optimal hemostasis and transfusion management, because CPB causes abnormalities in coagulation that may increase morbidity and mortality. The Ciba Corning 512 coagulation monitor (Ciba Corning, Medfield, MA) is a compact and portable device that rapidly determines the prothrombin time (PT) and activated partial thromboplastin time (APTT) in whole blood samples. One hundred patients requiring CPB had APTT and PT determined in whole blood specimens by the 512 coagulation monitor and in plasma specimens by the hospital laboratory from the same arterial blood sample obtained after protamine administration. Correlation coefficients of 0.95 and 0.77 were obtained for the paired APTT and PT tests, respectively (P < 0.01). A bias of 12.6 seconds and 0.77 seconds was determined for the APTT and PT, respectively. The 95% confidence intervals of the bias of the APTT and PT were 9.7 seconds to 15.5 seconds and 0.3 seconds to 1.16 seconds, respectively. The 512 coagulation monitor provided APTT and PT results in less than 3 minutes compared to approximately 45 minutes for the hospital laboratory. A reduction in accuracy was associated with the 512 coagulation monitor PT and APTT when different sampling sites were used. The 512 coagulation monitor accuracy was not affected by a variation of hemoglobin concentration or platelet count between 6 and 12 gm/dL and 15 to 300 · 109/L, respectively. In conclusion, the 512 coagulation monitor provided a rapid APTT and PT result, but the APTT was less accurate. Speeding access to hospital laboratory results would be even more efficacious and accurate.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Bick R.L.
        Hemostatic defects associated with cardiac surgery, prosthetic devices, and other extracorporeal circuits.
        Semin Thromb Hemost. 1985; 11: 249-280
        • Bachmann F.
        • McKenna R.
        • Cole E.R.
        • et al.
        The hemostatic mechanism after open-heart surgery.
        J Thorac Cardiovasc Surg. 1975; 70: 76-85
        • Barrer M.J.
        • Ellison N.
        Platelet function.
        Anesthesiology. 1977; 46: 202-211
        • Bick R.L.
        • Schmalhorst W.R.
        • Arbegast N.R.
        Alterations of hemostasis associated with cardiopulmonary bypass.
        Thromb Res. 1976; 8: 285-302
        • Edmunds L.H.
        • Ellison N.
        • Colman R.W.
        • et al.
        Platelet function during cardiac operation.
        J Thorac Cardiovasc Surg. 1982; 83: 805-812
        • Harker L.A.
        Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: Acquired transient platelet dysfunction associated with selective a-granule release.
        Blood. 1980; 56: 824-834
        • Harker L.A.
        Acquired disorders of platelet function.
        Ann NY Acad Sci. 1987; 509: 188-204
        • Mammen E.F.
        • Koets M.H.
        • Washington B.C.
        • et al.
        Hemostasis changes during cardiopulmonary bypass surgery.
        Semin Thromb Hemost. 1985; 2: 281-292
        • Tanaka K.
        • Takao M.
        • Yada I.
        • et al.
        Alterations in coagulation and fibrinolysis associated with cardiopulmonary bypass during open heart surgery.
        J Cardiothorac Anesth. 1987; 3: 181-188
        • Kurec A.S.
        • Morris M.W.
        • Davey F.R.
        Clotting, activated partial thromboplastin and coagulation times in monitoring heparin therapy.
        Ann Clin Lab Sci. 1979; 9: 494-500
        • Young J.A.
        • Kisker C.T.
        • Doty D.B.
        Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomers.
        Ann Thorac Surg. 1978; 26: 231-240
        • Rudisel P.T.
        • Moore L.A.
        Relationship between arterial and venous activated partial thromboplastin time values in patients after percutaneous transluminal coronary angioplasty.
        Heart Lung. 1989; 18: 514-519
        • Palermo L.M.
        • Andrews R.W.
        • Elison N.
        Avoidance of heparin contamination in coagulation studies drawn from indwelling lines.
        Anesth Analg. 1980; 59: 222-224
        • Reinhardt A.C.
        • Tonneson A.S.
        • Bracey A.
        • et al.
        Minimum discard volume from arterial catheters to obtain coagulation studies free of heparin's effect.
        Heart Lung. 1987; 16: 699-705
        • Gregerson R.A.
        • Underhill S.L.
        • Detter J.C.
        • et al.
        Accurate coagulation studies from heparinized radial artery catheters.
        Heart Lung. 1987; 16: 686-693
        • Cannon K.
        • Arrington M.K.
        • Fabian T.C.
        Prospective randomized evaluation of two methods of drawing coagulation studies from heparinized arterial lines.
        Heart Lung. 1985; 14: 392-395
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Gundry S.R.
        • Drongowski R.A.
        • Klein M.D.
        • et al.
        Postoperative bleeding in cardiovascular surgery: Does heparin rebound really exist?.
        Am Surg. 1989; 55: 162-165
        • Tremolada F.
        • Chiappetta F.
        • Noventa F.
        • et al.
        Prospective study of posttransfusion hepatitis in cardiac surgery patients receiving only blood or also blood products.
        Vox Sang. 1983; 44: 25-30
        • Conference C.
        Platelet transfusion therapy.
        JAMA. 1987; 257: 1777-1780
        • Braunstein A.H.
        • Oberman H.A.
        Transfusion of plasma components.
        Transfusion. 1984; 24: 281-286
        • Salzman E.W.
        Treatment with desmopressin acetate to reduce blood loss after cardiac surgery.
        N Engl J Med. 1986; 314: 1402-1406
        • Ellison N.
        • Jobes D.R.
        • Schwartz A.J.
        Implications of anticoagulation therapy.
        Int Anesthesiol Clin. 1982; 20: 121-135
        • Lucas F.V.
        • Duncan A.
        • Jay R.
        • et al.
        A novel whole blood capillary technique for measuring the prothrombin time.
        Am J Clin Path. 1987; 88: 442-446
        • Gravlee G.P.
        • Case L.D.
        • Angert K.C.
        • et al.
        Variability of the activated coagulation time.
        Anesth Analg. 1988; 67: 469-472
        • Esposito R.A.
        • Culliford A.T.
        • Covin S.B.
        • et al.
        The role of the activated clotting time in heparin administration and neutralization for cardiopulmonary bypass.
        J Thorac Cardiovasc Surg. 1983; 85: 174-185
        • Grindon A.J.
        • Tomasulo P.S.
        • Bergin J.J.
        • et al.
        The hospital transfusion committee: Guidelines for improving practice.
        JAMA. 1985; 253: 540-543

      Article info

      Footnotes

      ☆Supported in part by a grant from Ciba Coming, Medfield, MA.

      Identification

      DOI: https://doi.org/10.1016/1053-0770(93)90160-M

      Copyright

      © 1993 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX