Cardiothoracic & vascular anesthesia
Thromboelastometry and two activated clotting tests in detecting residual heparin after protamine in cardiac surgical patients: A prospective cohort study
Authors' conclusion
Both the ACT-LR and ACT+ tests of Hemochron Signature Elite device and the INTEM:HEPTEM CT ratio of ROTEM Sigma device have poor ability to detect residual heparin shortly after protamine administration.
Study context
- Population
- Adult elective cardiac surgical patients after protamine; University Hospital, September 2021 to February 2023
- Participants
- 55 patients
- Comparison
- ACT-LR and activated clotting time (ACT)+ (Hemochron Signature Elite) vs INTEM:HEPTEM coagulation time (CT) ratio (ROTEM Sigma) for detecting residual heparin after protamine
- Outcome
- Detection of residual heparin (postprotamine antifactor Xa (anti-fXa) ≥0.2 IU ml −1 vs ≤0.1 IU ml −1)
- Follow-up
- After protamine administration
Methodological detailssingle-centre
- Single-centre
Performance
As reported in the abstract
AUC to detect anti-fXa ≥0.2 IU ml −1 · postprotamine
| Test or model | AUC |
|---|---|
| INTEM:HEPTEM CT ratio | 0.496 (95% CI, 0.329 to 0.663) |
| ACT-LR | 0.425 (95% CI, 0.260 to 0.591) |
| ACT+ | 0.583 (95% CI, 0.417 to 0.749) |
AUC
INTEM:HEPTEM CT ratio0.496 (95% CI, 0.329 to 0.663)
ACT-LR0.425 (95% CI, 0.260 to 0.591)
ACT+0.583 (95% CI, 0.417 to 0.749)
Further findings
Mean, %
| Outcome | No residual heparin | Residual heparin | Mean bias (celite seconds) (95% CI) |
|---|---|---|---|
| Bias between ACT-LR and ACT+ measurementsACT-LR vs ACT+ | 44 (40–47) | ||
| % change postprotamine vs baseline ACT-LR, no residual heparin vs residual heparin | 5.9 (SD 17.5) | 1.4 (SD 8.4) | |
| % change postprotamine vs baseline ACT+, no residual heparin vs residual heparin | 5.9 (SD 16.9) | 9.9 (SD 12.5) |
Absolute changes in ACT-LR, ACT+ and INTEM:HEPTEM CT ratio, heparin vs no heparin
- Variable and did not differ between the groups
Original publication
Thromboelastometry and two activated clotting tests in detecting residual heparin after protamine in cardiac surgical patients: A prospective cohort study. Eur J Anaesthesiol. Published 10 February 2025. doi:10.
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