Comparison of MAX-ACT and K-ACT values when using bivalirudin anticoagulation during minimally invasive hybrid off-pump coronary artery bypass graft surgery

Philip M. Jones, Daniel Bainbridge, Wojciech Dobkowski, Christopher C. Harle, John M. Murkin, Philip S. Fernandes, Bob Kiaii

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)415-418
Number of pages4
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume25
Issue number3
DOIs
StatePublished - Jun 2011
Externally publishedYes

Keywords

  • activated coagulation time
  • anticoagulation
  • assay
  • bivalirudin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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