Comparison of activated clotting times measured using the Hemochron Jr. Signature and Medtronic ACT Plus during cardiopulmonary bypass with acute normovolemic haemodilution

Jung Min Lee, Eun Young Park, Kyung Mi Kim, Jong Chan Won, Tack Koon Jung, Soo Kyung Lee, Jung Min Lee, Eun Young Park, Kyung Mi Kim, Jong Chan Won, Tack Koon Jung, Soo Kyung Lee

Abstract

Objective This study compared the activated clotting time (ACT) measured using the Hemochron Jr. Signature (HACT) with the ACT measured using the Medtronic ACT Plus (MACT) during cardiopulmonary bypass (CPB) with acute normovolemic haemodilution (ANH) in patients undergoing cardiac surgery. Methods The ACT was checked at baseline with both devices after inducing anaesthesia, and 400 to 800 mL of whole blood was withdrawn to induce moderate ANH. Before initiating CPB, a 300-IU/kg bolus dose of heparin was administered to maintain the HACT at >400 s; protamine was later given to reverse the anticoagulation. The ACT was checked using both devices at baseline, during heparinisation, and after protamine administration. Results In total, 106 pairs of samples from 29 patients were analysed. The ACT showed a good correlation between the two devices (r = 0.956). However, Bland-Altman analysis showed that the MACT was higher, particularly at baseline and during heparinisation. Multiple regression analysis showed that the blood glucose concentration significantly influenced the differences between the two ACT devices. Conclusions The HACT was lower than the MACT during CPB with ANH in patients undergoing cardiac surgery. Clinicians should be cautious when using each ACT device within generally accepted reference ACT values.

Keywords: Activated clotting time; cardiac surgery; cardiopulmonary bypass; haemodilution; heparin; kaolin.

Figures

Figure 1.
Figure 1.
Linear regression analysis of activated clotting times measured with the Hemochron Jr. and Medtronic ACT Plus during cardiac surgeries with cardiopulmonary bypass and acute normovolemic haemodilution (n = 106, r = 0.956, p = 0.0001). ACT, activated clotting time; SD, standard deviation.
Figure 2.
Figure 2.
Bland–Altman analysis of activated clotting times measured with the Medtronic ACT Plus and Hemochron Jr. (n = 106). ACT, activated clotting time; SD, standard deviation.
Figure 3.
Figure 3.
Linear regression analysis of activated clotting times measured with the Hemochron Jr. and Medtronic ACT Plus during cardiac surgeries with cardiopulmonary bypass and acute normovolemic haemodilution. (a) During heparinisation (n = 30, r = 0.772, p = 0.0001). (b) After protamine administration (n = 44, r = 0.32, p = 0.034). ACT, activated clotting time.
Figure 4.
Figure 4.
Bland–Altman analysis of activated clotting times measured using the Medtronic ACT Plus and Hemochron Jr. (a) During heparinisation (n = 30). (b) After protamine administration (n = 44). ACT, activated clotting time; SD, standard deviation.
Figure 5.
Figure 5.
(a) Linear regression analysis of rHACT and rMACT (n = 74, r = 0.945, p < 0.0001) and (b) Bland–Altman analysis of rHACT and rMACT during cardiac surgeries with cardiopulmonary bypass and acute normovolemic haemodilution. rHACT = HACT after heparinisation or protamine injection/HACT at baseline; rMACT = MACT after heparinisation or protamine injection/MACT at baseline (where HACT is the ACT measured using the Hemochron Jr. Signature and MACT is the ACT measured using the Medtronic ACT Plus). ACT, activated clotting time; SD, standard deviation.
Figure 6.
Figure 6.
Linear regression analysis showing correlation between the glucose level and the difference in the activated clotting time measured using the Medtronic ACT Plus and Hemochron Jr. (n = 104, r = 0.347, p = 0.0001). ACT, activated clotting time.
Figure 7.
Figure 7.
Linear regression analysis showing the correlation between the glucose level and difference in the activated clotting time measured using the Medtronic ACT Plus and Hemochron Jr. (a) at baseline (n = 32, r = 0.403, p = 0.022) and (b) during heparinisation (n = 30, r = 0.503, p = 0.005). ACT, activated clotting time.
Figure 8.
Figure 8.
Linear regression analysis showing correlation between the glucose level and the activated clotting time measured using the Medtronic ACT Plus (a) at baseline (n = 32, r = 0.471, p = 0.007) and (b) during heparinisation (n = 30, r = 0.410, p = 0.024). ACT, activated clotting time.

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