Methodenvergleich zur Erfassung einer Restheparinisierung nach kardiochirurgischen Eingriffen mit Herz-Lungen-Maschine

Residual heparinization after cardiopulmonary bypass – A prospective comparison of methods

von Nadine Hillmann
Dissertation
Datum der mündl. Prüfung:2016-12-14
Erschienen:2016-12-12
Betreuer:Prof. Dr. Anselm Bräuer
Gutachter:PD Dr. Joachim Riggert
Gutachter:Prof. Dr. Margarete Schön
Zum Verlinken/Zitieren: http://dx.doi.org/10.53846/goediss-6027

 

 

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Englisch

Postoperative bleeding is a common complication after cardiac surgery applying cardiopulmonary bypass. One reason might be a residual heparinization. The aim of this study was twofold: first, it was examined whether the administered pump blood had an effect on the patients’ haemostasis after the extracorporeal circulation. Second, it was investigated which laboratory techniques are most suitable to identify the residual heparinization. The design of the study was as follows: The antifactor-Xa-activity and standard coagulation parameters including thrombin time (TT) and activated partial thromboplastin time (aPTT) of 100 consecutive patients undergoing cardiac surgery were detected at three measuring points. The first measuring point was at baseline, i.e. preoperative (T1), the second measurement took place after the termination of the extracorporeal circulation (T2), and third measurement was after administering the pump blood (T3). In addition, ‘Point of Care’ (POC) methods including the thrombelastometry (ROTEM®), the activated clotting time (ACT) (Haemochron®, Hepcon®), and the protamine titration (Hepcon®) were performed at T2 and T3. The incidence of patients with an antifactor-Xa-activity >0.4 IU/ml was overall small. The ROC-analyses for ACT and thrombelastometry were not significantly different from 0.5. Furthermore, the Clotting Time (CT) HEPTEM was longer compared to the CT INTEM in 74 of 190 cases. Through the application of conventional coagulation measurements (aPTT, TT) as well as the protamine titration, significant differences could be detected between a residual heparinization and other causes of an impaired coagulation. The administered pump blood increased the antifactor-Xa-activity only occasionally. In this study, a possible interference was identified through the HEPTEM of the ROTEM®-method particularly after finishing the extracorporeal circulation. On the other hand, the protamine titration using Hepcon® proved to be a secure technique to detect residual heparinization after cardiac surgery. Also, the aPTT proved to be a valid method, although being to slow in an emergency situation.
Keywords: Postoperative bleeding; cardiac surgery; residual heparinization; pump blood; extracorporeal circulation; antifactor-Xa-activity; activated partial thromboplastin time (aPTT); thrombelastometry (ROTEM®); the activated clotting time (ACT); protamine titration (Hepcon®); Clotting Time (CT) HEPTEM; Clotting Time (CT) INTEM
 
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