- Nicolau-Raducu, Ramona; Occhipinti, Elise; Marshall, Thomas; Koveleskie, Joseph; Ganier, Donald; Evans, Brian; Daly, William; Fish, Brian; Cohen, Ari J.; Reichman, Trevor W.; Bruce, David; Bohorquez, Humberto; Seal, John; Ahmed, Emily; Carmody, Ian; Loss, George; Rayburn, Jonathan; Nossaman, Bobby
- Objectives: The purpose of this study was to compare the agreement between two heparin assays, Hepcon HMS plus/Kaolin-ACT and Anti-Xa, and their predictive power in detecting circulating heparin levels post-reperfusion of the liver graft when compared with thromboelastogram (TEG) r time ratio in patients undergoing orthotopic liver transplantation (OLT).; Design: Prospective, observational cohort study design.; Setting: Single center, university hospital.; Participants: Thirty-eight consecutive adults who had undergone liver transplant.; Interventions: None.; Measurements and Main Results: Paired arterial blood samples were collected before surgical incision, 5 minutes after administration of an average dose of 2,054 771 units of intravenous unfractionated heparin before caval cross-clamping, 5 minutes after portal reperfusion, 5 minutes after hepatic artery reperfusion, and 1 hour after hepatic artery reperfusion. The observations that heparin assay measurements were within the predetermined limits of agreement, strongly suggested the two heparin assays (Hepcon HMS plus and Anti-Xa assay) are interchangeable during prophylactic heparin dose therapy during OLT. Post-reperfusion, receiver operating characteristic curve analysis revealed high accuracy in measuring circulating heparin levels with both Anti-Xa and Hepcon HMS assays when compared with the TEG r time ratio assay.; Conclusions: The point-of-care Hepcon HMS plus/Kaolin-ACT (activated clotting time) assay appeared to be a reliable alternative to the more expensive and laboratory-required Anti-Xa assay in monitoring the response to intravenous heparin in patients undergoing OLT. (C) 2017 Elsevier Inc. All rights reserved.
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