Abstract

Heparin Monitoring During Cardiopulmonary Bypass Surgery Using the One-Step Point-of-Care Whole Blood Anti-Factor-Xa Clotting Assay Heptest-POC-Hi

^* Institute of Hemostaseology and Transfusion Medicine, Ludwigshafen, Germany
^† Heart Center, Department of Cardiac Surgery, Academic City Hospital, Ludwigshafen, Germany

Address correspondence to: Peter Hellstern, MD, Academic City Hospital, Institute of Hemostaseology and Transfusion Medicine, D-67063 Ludwigshafen, Germany. E-mail: peterhellstern@medicusnet.de

Abstract

The activated clotting time (ACT) generally used for monitoring heparinization during cardiopulmonary bypass (CPB) surgery does not specifically measure heparin anticoagulant activities. This may result in heparin over- or under-dose and subsequent severe adverse events. A new point-of-care whole blood clotting assay (Heptest POC-Hi [HPOCH]) for quantifying heparin anticoagulant activity specifically was compared with ACT and anti-factor Xa (anti-Xa) heparin plasma levels (Coatest heparin) in 125 patients undergoing CPB surgery. The analytical reliability of the HPOCH and the influence of preanalytical variables on assay results were also examined. The ACT and HPOCH clotting times determined throughout the entire observation period correlated closely (n = 683; r = 0.80; p < .0001). Similarly, there was a significant linear correlation between HPOCH and Coatest anti-Xa levels (n = 352; r = 0.87; p < .0001). Pre- and post-CBP values of HPOCH, ACT, and anti-Xa plasma levels correlated closely with each other (correlation coefficients between r = 0.90 and r = 0.99; p < .0001). During CPB, there was no significant relationship between ACT and whole blood or plasma heparin levels determined by HPOCH (n = 157; r = 0.19) and the chromogenic anti-Xa assay (n = 157; r = 0.04), respectively. In contrast, HPOCH and anti-Xa plasma levels correlated strongly during CPB (n = 157; r = 0.57; p < .0001). However, bias analysis showed that the HPOCH and Coatest heparin could not be used interchangeably. The HPOCH was well reproducible and not influenced by aprotinin, hemodilution, or other factors affecting ACT. The HPOCH seems to be a promising new tool for specific on-site measurement of heparin activities in whole blood during CPB.