Objectives
To determine the onset of heparin anticoagulation, using 2 different measures of activated
clotting times (ACT), thromboelastography (TEG; R-time), and anti-Xa levels, after
administering low- (100 U/kg) and high- (300 U/kg) dose intravenous (IV) heparin to
patients undergoing transcatheter aortic valve replacement (TAVR) and cardiac surgery,
respectively.
Design
Prospective study.
Setting
Single academic institution.
Participants
Patients with normal baseline coagulation presenting for TAVR or cardiac valve surgery.
Interventions
Coagulation studies were performed at baseline, 30 seconds, 90 seconds, and 180 seconds
after IV heparin administration. The tests included iSTAT (iACT) and Hemochron ACT
(hACT), TEG R-Time, and anti-Xa levels. At the authors’ institution, anti-Xa is the
preferred measure of heparin anticoagulation when time permits. ACT, a rapid point-
of-care test, is used to assess intraprocedural anticoagulation.
Measurements and Main Results: After both low- and high-dose heparin, there are peak increases in ACT and anti-Xa
at 30 seconds, followed by a decline at 90 seconds and plateau at 180 seconds. The
TEG R-time remained elevated (>80 minutes) throughout. For TAVR cases, all anti-Xa
was >1.5 IU/mL, and was associated with an iACT >180 seconds and an hACT >200 seconds.
For cardiac valve surgery cases, all anti-Xa was >2.4 and associated with an iACT
>420 seconds and and hACT >340 seconds. Compared with hACT, iACTs were significantly
lower at all time points after low-dose heparin, but not after high-dose heparin.
Conclusions
In this pilot study, heparin anticoagulation was detected as early as 30 seconds after
IV administration, based on ACT, anti-Xa levels, and TEG R-time.
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Published online: August 04, 2022
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