Tags Archives: heparin

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Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review

Abstract Background: Heparin is the widely used anti-coagulation strategy for patients on extracorporeal membrane oxygenation (ECMO). Nevertheless, heparin-induced thrombocytopenia (HIT) and acquired anti-thrombin (AT) deficiency preclude the use of heparin..

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2020 Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation (Management of).Guidelines

Preamble Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and..

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Heparin-Induced Thrombocytopenia

Abstract Heparin-induced thrombocytopenia is an immune-mediated disorder caused by antibodies that recognize complexes of platelet factor 4 and heparin. Thrombosis is a central and unpredictable feature of this syndrome. Despite..

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ECMO Biocompatibility: Surface Coatings, Anticoagulation, and Coagulation Monitoring

Abstract The interaction between the patient and the ECMO (extracorporeal membrane oxygenation) circuit initiates a significant coagulation and inflammatory response due to the large surface area of foreign material contained..

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Veno-arterial extracorporeal membrane oxygenation without therapeutic anticoagulation for intra-operative cardiopulmonary support during lung transplantation

Abstract Cardiopulmonary support is frequently required during lung transplantation. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been recently shown to be an acceptable and, perhaps, safer alternative to cardiopulmonary bypass machine..

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Use of a fixed, body weight-unadjusted loading dose of unfractionated heparin for extracorporeal cardiopulmonary resuscitation

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is being used increasingly in the emergency and critical care field in Japan. A major complication of ECPR is bleeding; however, the optimal initial..

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Prevalence and Overtesting of True Heparin-Induced Thrombocytopenia in a 591-Bed Tertiary Care, Teaching Hospital

Abstract Heparin-induced thrombocytopenia type II (HIT) is a rare but potentially fatal antibody-mediated reaction to all forms of heparin (unfractionated heparin, low-molecular weight heparin, heparin flushes, and heparin-coated catheters), which..

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Direct oral anticoagulants and heparins: laboratory values and pitfalls in ‘bridging therapy’

Abstract OBJECTIVES:  The three direct oral anticoagulants (DOACs) dabigatran, apixaban and rivaroxaban are now widely used in clinical practice. For patients requiring perioperative interruption of DOACs, heparin bridging is still..

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Thromboelastography during coronary artery bypass grafting surgery of severe hemophilia A patient – the effect of heparin and protamine on…

Abstract Coronary artery bypass grafting surgery (CABG) in hemophilia patients is challenging. Thromboelastography (TEG) is useful to assess hemostasis perioperatively. A patient with severe hemophilia A underwent CABG with TEG studies...

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Pilot validation of an individualised pharmacokinetic algorithm for protamine dosing after systemic heparinisation for cardiopulmonary bypass

Abstract Introduction: This manuscript represents a pilot study assessing the feasibility of a single-compartment, individualised, pharmacokinetic algorithm for protamine dosing after cardiopulmonary bypass. Methods: A pilot cohort study in a..

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The Impact and Statistical Analysis of a Multifaceted Anticoagulation Strategy in Children Supported on ECMO: Performance and Pitfalls

Abstract Background: We sought to determine whether the introduction of a new anticoagulation protocol improved the frequency with which target anticoagulation parameters were met in children supported with extracorporeal membrane..

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Evaluation of a New Sonoclot Device for Heparin Management in Cardiac Surgery

Abstract Background: Sonoclot is used to measure kaolin-based activated clotting time (kACT) for heparin management. Apart from measuring kACT, the device assesses the patient’s coagulation status by glass bead–activated tests..

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Antibodies against heparin-protamine complexes: Effect and clinical relevance

Abstract The study by Grieshaber and colleagues, “Platelet-activating protamine-heparin-antibodies lead to higher protamine demand in patients undergoing cardiac surgery,” in this issue of the Journal, is a prospective study that joins other..

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Different Heparin Contents in Prothrombin Complex Concentrates May Impair Blood Clotting in Outpatients With Ventricular Assist Devices Receiving Phenprocoumon

Abstract Objectives  (PCCs) are used to rapidly reverse  by oral . They differ in the content of , endogenous anticoagulants, and heparin. The authors hypothesized that PCCs’ specific heparin content may compromise the  effect...

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Postoperative Management for Patients With Durable Mechanical Circulatory Support Devices

Abstract Mechanical circulatory support devices have been approved as bridge to transplantation, as bridge to recovery, or as destination therapy to treat end-stage heart failure. The perioperative challenges for the..

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Heparin Resistance Is Common in Patients Undergoing Extracorporeal Membrane Oxygenation but Is Not Associated with Worse Clinical Outcomes

Abstract Extracorporeal membrane oxygenation (ECMO) protocols generally require systemic anticoagulation with heparin to prevent circuit thrombosis. The prevalence, risk factors, and outcomes of heparin resistance in this setting are ill-defined. To better..

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Challenges with heparin-based anticoagulation during cardiopulmonary bypass in children: Impact of low antithrombin activity

Abstract Background  is one of the main natural  inhibitors. It is potentiated by heparin, and may be a key component of heparin response, particularly in infants aged <1 year. We sought to..

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Thromboelastometry, Thromboelastography, and Conventional Tests to Assess Anticoagulation During Extracorporeal Support: A Prospective Observational Study

Abstract Optimal anticoagulation monitoring in patients with extracorporeal membrane oxygenation (ECMO) is fundamental to avoid hemorrhagic and thromboembolic complications. Besides conventional coagulation tests, there is growing interest in the use..

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Double-Blind, Randomized, Placebo-Controlled Trial Comparing the Effects of Antithrombin Versus Placebo on the Coagulation System in Infants with Low Antithrombin…

Abstract Objectives To determine whether precardiopulmonary bypass (CPB) normalization of  levels in infants to 100% improves heparin sensitivity and  during CPB and has beneficial effects into the . Design Randomized, double-blinded, placebo-controlled prospective..

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Evaluation of Systemic Heparin Versus Bivalirudin in Adult Patients Supported by Extracorporeal Membrane Oxygenation

Abstract Systemic anticoagulation is a standard of care in adult patients supported by extracorporeal membrane oxygenation (ECMO) to prevent circuit thrombosis and subsequent thromboembolic events. Unfractionated heparin has long been..

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Assessment of Heparin Anticoagulation Measured Using i-STAT and Hemochron Activated Clotting Time

Objective Adequate , measured using  (ACT), is important during vascular and cardiac surgeries. Unfractionated heparin is the most common  used. The purpose of this analysis was to compare the i-STAT ACT (iACT) to..

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An introduction to point-of-care testing in extracorporeal circulation and LVADs

Abstract There is a delicate balance between bleeding and clotting in patients on circuits such as ventricular assist devices or extracorporeal membrane oxygenation. Traditional coagulation tests, prothrombin time, activated partial..

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Heparin–protamine balance after neonatal cardiopulmonary bypass surgery

Abstract Essentials   Heparin‐protamine balance (HPB) modulates bleeding after neonatal cardiopulmonary bypass (CPB). HPB was examined in 44 neonates undergoing CPB. Post‐operative bleeding occurred in 36% and heparin rebound in..

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Calculation Algorithm Reduces Protamine Doses Without Increasing Blood Loss or the Transfusion Rate in Cardiac Surgery: Results of a Randomized…

Abstract Objectives The aim of the study was to investigate whether the HeProCalc algorithm affects heparin and  dosage, , and transfusion rate. Design Randomized controlled trial. Setting University hospital. Participants The..

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Anticoagulation with VADs and ECMO: walking the tightrope

Abstract The evolution of devices for mechanical circulatory support (MCS), including ventricular assist devices (VADs) for patients with heart failure and extracorporeal membrane oxygenation (ECMO) for patients with acute cardiac..

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Heparin–protamine balance after neonatal cardiopulmonary bypass surgery

Abstract Essentials   Heparin‐protamine balance (HPB) modulates bleeding after neonatal cardiopulmonary bypass (CPB). HPB was examined in 44 neonates undergoing CPB. Post‐operative bleeding occurred in 36% and heparin rebound in..

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Comparative Pharmacological Profiles of Various Bovine, Ovine, and Porcine Heparins

Abstract Unfractionated heparin is the first anticoagulant drug and has been successfully used clinically for over 80 years. Heparin and its analogues are used during surgery and dialysis and are..

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Cartridge-Based Thromboelastography Can Be Used to Monitor and Quantify the Activity of Unfractionated and Low-Molecular-Weight Heparins

Abstract Thromboelastography is increasingly utilized in the management of bleeding and thrombotic complications where heparin management remains a cornerstone. This study assessed the feasibility of the cartridge-based TEG® 6s system (Haemonetics..

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The effect of protamine dosing variation on bleeding and transfusion after heparinisation for cardiopulmonary bypass

Abstract Introduction: Accurate dosing of protamine reversal following on-pump cardiac surgical procedures is challenging, with both excessive and inadequate administration recognised to increase bleeding risk. We aimed to examine the..

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Predictors of Heparin Resistance Before Cardiovascular Operations in Adults

Background Heparin resistance (HR) is often encountered during cardiovascular operations that require cardiopulmonary bypass. Clinical risk factors and the mechanism underlying heparin resistance are yet to be determined. The aim..

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