Comparison of MAX-ACT and K-ACT Values When Using Bivalirudin Anticoagulation During Minimally Invasive Hybrid Off-Pump Coronary Artery Bypass Graft Surgery

Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, Ontario, Canada.
Journal of cardiothoracic and vascular anesthesia (Impact Factor: 1.46). 02/2011; 25(3):415-8. DOI: 10.1053/j.jvca.2010.12.007
Source: PubMed


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.
A prospective, observational study.
A cardiac surgical operating room of a university-affiliated hospital.
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.
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.
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).
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.

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