TY - JOUR
T1 - Comparison of MAX-ACT and K-ACT values when using bivalirudin anticoagulation during minimally invasive hybrid off-pump coronary artery bypass graft surgery
AU - Jones, Philip M.
AU - Bainbridge, Daniel
AU - Dobkowski, Wojciech
AU - Harle, Christopher C.
AU - Murkin, John M.
AU - Fernandes, Philip S.
AU - Kiaii, Bob
PY - 2011/6
Y1 - 2011/6
N2 - Objective: To compare the kaolin-activated coagulation time (K-ACT) to the MAX-ACT for monitoring anticoagulation with bivalirudin in patients undergoing hybrid off-pump coronary artery revascularization procedures. Design: A prospective, observational study. Setting: A cardiac surgical operating room of a university-affiliated hospital. Participants: Twelve patients undergoing off-pump coronary artery bypass graft surgery and percutaneous coronary intervention during the same procedure anticoagulated with bivalirudin to a target K-ACT of >300 seconds. Intervention: At baseline and at frequent intervals during anticoagulation, K-ACT and MAX-ACT assays were run contemporaneously, and the pairs of results were analyzed with descriptive statistics, by correlation analysis, and with Bland-Altman analysis. Measurements and Main Results: The MAX-ACT and K-ACT assays were highly correlated, but the MAX-ACT assay consistently reported significantly lower ACT values compared with the K-ACT. The mean bias (K-ACT minus MAX-ACT) was 94 seconds (limits of agreement, 51-138 seconds). Conclusion: To maximize patient safety, centers using bivalirudin for anticoagulation during cardiac surgical procedures need to be aware of the different performance characteristics of ACT assay subtypes.
AB - Objective: To compare the kaolin-activated coagulation time (K-ACT) to the MAX-ACT for monitoring anticoagulation with bivalirudin in patients undergoing hybrid off-pump coronary artery revascularization procedures. Design: A prospective, observational study. Setting: A cardiac surgical operating room of a university-affiliated hospital. Participants: Twelve patients undergoing off-pump coronary artery bypass graft surgery and percutaneous coronary intervention during the same procedure anticoagulated with bivalirudin to a target K-ACT of >300 seconds. Intervention: At baseline and at frequent intervals during anticoagulation, K-ACT and MAX-ACT assays were run contemporaneously, and the pairs of results were analyzed with descriptive statistics, by correlation analysis, and with Bland-Altman analysis. Measurements and Main Results: The MAX-ACT and K-ACT assays were highly correlated, but the MAX-ACT assay consistently reported significantly lower ACT values compared with the K-ACT. The mean bias (K-ACT minus MAX-ACT) was 94 seconds (limits of agreement, 51-138 seconds). Conclusion: To maximize patient safety, centers using bivalirudin for anticoagulation during cardiac surgical procedures need to be aware of the different performance characteristics of ACT assay subtypes.
KW - activated coagulation time
KW - anticoagulation
KW - assay
KW - bivalirudin
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U2 - 10.1053/j.jvca.2010.12.007
DO - 10.1053/j.jvca.2010.12.007
M3 - Article
C2 - 21295997
AN - SCOPUS:79957760668
VL - 25
SP - 415
EP - 418
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 3
ER -