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Real-Time Individualization of UFH Dosing in Cardiac Procedures: Development and Validation of an Online ACT-Based Target-Controlled Tool

Abstract Objectives To develop and validate, a real-time algorithm to individualize unfractionated heparin (UFH) dosing based on activated clotting time (ACT) dynamics in cardiac procedures with or without cardiopulmonary bypass..

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Bivalirudin Monitoring Using Dilute Thrombin Time in Pediatric Extracorporeal Membrane Oxygenation: Single-Center, Retrospective Cost Analysis, 2018–2023

Abstract Objectives:  The parenteral anticoagulant bivalirudin has favorable safety and efficacy outcomes compared with unfractionated heparin (UFH) in pediatric patients requiring extracorporeal membrane oxygenation (ECMO), and is frequently monitored using..

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Evaluation of bivalirudin-based anticoagulation for extracorporeal membrane oxygenation, including patients with COVID-19

Abstract Background: Although unfractionated heparin (UFH) has traditionally been used for anticoagulation during extracorporeal membrane oxygenation (ECMO), bivalirudin may be preferred due to fewer complications. A prior medication use evaluation..

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Prolonged Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation in Sheep

Abstract Clinically significant bleeding is a common complication of extracorporeal membrane oxygenation (ECMO), with bleeding observed in upwards of 40% of patients. Bleeding is strongly associated with systemic anticoagulation, which..

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Contemporary Clinical Practices in Anticoagulation Management During Cardiopulmonary Bypass: A Europe-Wide Survey

Abstract Objectives Clinical practice in anticoagulation management, particularly in heparin administration, monitoring, reversal and haemostasis, is known to differ significantly. To better characterize this variability, we conducted a Europe-wide survey..

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Contemporary Clinical Practices in Anticoagulation Management During Cardiopulmonary Bypass: A Europe-Wide Survey

Abstract Objectives Clinical practice in anticoagulation management, particularly in heparin administration, monitoring, reversal and haemostasis, is known to differ significantly. To better characterize this variability, we conducted a Europe-wide survey..

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Comparison between regional citrate anticoagulation and systemic heparin anticoagulation in patients undergoing continuous renal replacement therapy and venoarterial extracorporeal membrane…

Abstract Introduction Regional citrate anticoagulation (RCA) is the recommended first-line strategy for continuous renal replacement therapy (CRRT) circuits. Acute kidney injury is common in patients undergoing venoarterial extracorporeal membrane oxygenation..

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Smart Clot: An Automated Point-of-Care Flow Assay for Quantitative Whole-Blood Platelet, Fibrin, and Thrombus Kinetics

Abstract Hemostasis depends on the coordinated interaction between platelets, coagulation factors, endothelium, and shear forces. Current point-of-care (POC) assays evaluate isolated components of haemostasis or operate under nearly static conditions,..

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Association Between Systemic Anticoagulation and Outcomes in Patients With Acute Respiratory Distress Syndrome Receiving Venovenous Extracorporeal Membrane Oxygenation: Insights From…

Abstract Objective:  To evaluate whether systemic anticoagulation therapy affects the survival of adult patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) for acute respiratory distress syndrome (ARDS). Design:  Multicenter retrospective study...

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Advances in Heparin Reversal Agents: Design Strategies, Structural Features, and Pharmacological Insights

Abstract Heparin is among the most widely used anticoagulants worldwide, with an annual market of ∼$4 billion. It also poses potential bleeding risks (0.5–5%), occasionally life-threatening, necessitating heparin reversal agents...

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Successful management of IgE-mediated protamine allergy in cardiac surgery: bicentric case report

Abstract Since the use of heparin reversed by protamine is the gold standard for anticoagulation during cardiopulmonary bypass (CPB), a documented allergy to protamine represents a serious challenge for cardiac..

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Combined Antithrombin and Heparin Supplementation to Blood for Restoring Heparin Responsiveness After Andexanet Alfa Exposure: An In Vitro Model

Abstract Background: Andexanet alfa, a Gla-domainless mutant factor Xa (GDXa), reverses oral FXa inhibitors but can cause severe heparin resistance during cardiopulmonary bypass (CPB). Antithrombin (AT) supplementation may mitigate this..

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Optimising protamine dosing for heparin reversal after cardiopulmonary bypass: a population pharmacokinetic–pharmacodynamic study

Abstract Background Protamine is administered to reverse unfractionated heparin (UFH) after cardiopulmonary bypass (CPB), but dosing strategies—typically based on protamine-to-heparin (P:H) ratios—vary, and the minimal effective dose remains unclear. Reversal..

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Increased Incidence of Thrombosis in Patients at Risk of Heparin-Induced Thrombocytopenia Receiving Epoprostenol for Cardiac Surgery

Abstract Objective Heparin-induced thrombocytopenia (HIT) is a serious concern in cardiac surgery, as heparin use in the at-risk patient can lead to devastating thrombosis. Management strategies for patients with confirmed..

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Acute pulmonary hypertension induced by heparin–protamine complex during thoracoabdominal aortic grafting

Abstract Background Protamine has a more difficult side-effect profile. Circulatory collapse has been reported as a result of acute pulmonary artery spasm caused by complement cascade activation by large heparin–protamine..

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Beyond Concentration: Importance of Functional and Temporal Assessment of Fibrinogen After Cardiopulmonary Bypass

Abstract Terada et al. presented an important study on the dynamic relationship between plasma fibrinogen concentration and functional clot strength after cardiopulmonary bypass (CPB). Their findings underscore the multifactorial nature of..

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Anticoagulation Management of Patients with Antiphospholipid Syndrome Undergoing Cardiopulmonary Bypass in Cardiac Surgery: Challenges and Current Strategies

Abstract The antiphospholipid syndrome (APS) is a complex autoimmune disease that causes a state of hypercoagulability that can result in recurrent venous and arterial thromboses. APS may lead to cardiac..

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Standard coagulation assays during cardiopulmonary bypass predict post-bypass levels in cardiac surgery

Abstract Background Cardiac surgery with cardiopulmonary bypass (CPB) requires precise hemostasis management to limit postoperative bleeding. Fibrinogen, platelet count, and pro-coagulant factors guide transfusion decisions, yet Clauss fibrinogen measurement during..

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Correlation of anticoagulation assays with bleeding during extracorporeal membrane oxygenation at a tertiary pediatric hospital

Abstract Introduction Due to anticoagulation during Extracorporeal Membrane Oxygenation (ECMO), patients face a higher risk of bleeding. This study aimed to assess the correlation between anticoagulation assays and hemorrhage in..

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Automated Thromboelastometry for Semiquantitative Assessment of High Heparin Concentrations: A Feasibility Study in Healthy Volunteers

Abstract Background and Aims To date, thromboelastometry has not been investigated as an assay to monitor profound heparin anticoagulation, such as is required for a safe cardiopulmonary bypass (CPB). The..

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Postoperative reduction in thrombin generation induced by elevated levels of tissue factor pathway inhibitor in cardiac surgery: a prospective observational…

Abstract Purpose Tissue factor pathway inhibitor (TFPI) is an intrinsic anticoagulant factor, and its plasma concentration is elevated by heparin administration. Because several hours are required to return to normal..

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Mortality and complications in low-dose vs standard-dose unfractionated heparin anticoagulation for extracorporeal membrane oxygenation: a systematic review and meta-analysis

Abstract Background Controversies exist in anticoagulation practices in extracorporeal membrane oxygenation (ECMO). It is uncertain whether the intensity of anticoagulation affects ECMO outcomes. Objectives To conduct a meta-analysis to determine..

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Heparin: Over 100 Years of Anticoagulation

Abstract This chapter provides an overview of heparin, including discovery, structure, mechanism of action, and principal use for anticoagulation. For over 100 years, heparin has a central role in prophylaxis..

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Detecting Heparin Contamination in Prolonged APTT with a Heparin-Resistant Solution

Abstract The activated partial thromboplastin time (APTT) assay is essential for evaluating coagulation. However, prolonged APTT may result from pathological conditions or contamination with unfractionated heparin (UFH), which can occur..

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Staged mechanical circulatory support in paediatric HIT: Bivalirudin anticoagulation across ECMO, VAD, and cardiac transplantation

Abstract Introduction Heparin induced thrombocytopenia (HIT) with in paediatric population is rare and subsequent anticoagulation management is challenging. Bivalirudin is a viable alternative to heparin for anticoagulating paediatric patients with..

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Increasing Anticoagulation Intensity in the Oxygenator During Flow Reduction Trials in Venoarterial Extracorporeal Membrane Oxygenation

Abstract Anticoagulation is mandatory during venoarterial extracorporeal membrane oxygenation (V-A ECMO) flow reduction trials with very low blood flow. Anticoagulation in the ECMO circuit might be intensified with less effect..

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Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management

Abstract Background: Unfractionated heparin (UFH) is the standard anticoagulant during cardiopulmonary bypass (CPB). A clinically relevant subset develops heparin resistance (HR)—failure to reach adequate anticoagulation with usual UFH—raising thrombotic risk..

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Use of Andexanet Alfa to Reverse Heparin After Cardiopulmonary Bypass

Abstract Heparin is the primary anticoagulant used for cardiopulmonary bypass and requires reversal to prevent postoperative bleeding. Protamine sulfate is the only United States Food and Drug Administration–approved heparin reversal..

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Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management

Abstract Background: Unfractionated heparin (UFH) is the standard anticoagulant during cardiopulmonary bypass (CPB). A clinically relevant subset develops heparin resistance (HR)—failure to reach adequate anticoagulation with usual UFH—raising thrombotic risk..

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Effects of intraoperative cell salvage versus preoperative autologous blood donation on postoperative coagulation in cardiac surgery

Abstract  Objective: To compare the effects of intraoperative cell salvage (ICS) and preoperative autologous blood donation (PABD) on postoperative coagulation and platelet function in patients undergoing cardiac surgery, and to..

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