Efficacy of the Hepcon system in reducing hemorrhagic and thrombotic complications in antiphospholipid syndrome patients undergoing cardiac surgery.

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  • Additional Information
    • Source:
      Publisher: SAGE Publications Country of Publication: England NLM ID: 8700166 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1477-111X (Electronic) Linking ISSN: 02676591 NLM ISO Abbreviation: Perfusion Subsets: MEDLINE
    • Publication Information:
      Publication: London : SAGE Publications
      Original Publication: [London] : Edward Arnold, [c1986-
    • Subject Terms:
      Antiphospholipid Syndrome*/complications ; Antiphospholipid Syndrome*/blood ; Thrombosis*/etiology ; Thrombosis*/prevention & control ; Cardiac Surgical Procedures*/methods ; Cardiac Surgical Procedures*/adverse effects; Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Hemorrhage/etiology ; Aged ; Adult ; Cardiopulmonary Bypass/methods ; Cardiopulmonary Bypass/adverse effects
    • Abstract:
      Introduction: Patients with Antiphospholipid Syndrome (APS) undergoing cardiopulmonary bypass (CPB) surgery are at increased risk for thrombotic and hemorrhagic complications. Anticoagulation during CPB is typically monitored with activated clotting time (ACT) which may be falsely prolonged in patients with APS. The Hepcon Hemostasis Management System quantitatively determines the whole blood heparin concentration through heparin/protamine titration.
      Methods: This was a retrospective study of APS patients who underwent cardiac surgery requiring CPB at the Cleveland Clinic between April 2013, and July 2020. The primary endpoint was the composite rate of hemorrhagic or thromboembolic complications per surgical case in patients monitored by Hepcon versus patients monitored by ACT. Secondary endpoints were median volume of chest tube output and packed red blood cell (PRBC) transfusion within the first three post-operative days.
      Results: 43 patients were included. 20 (47%) patients were monitored using Hepcon while 23 (53%) were monitored using ACT. For the primary endpoint of rate of thromboembolic or hemorrhagic complications per surgical case, there was no statistically significant difference between the Hepcon and ACT groups (HMS, 6/20 [30%]; ACT, 7/23 [30%]; p = >0.99). For the secondary endpoints, there was no statistically significant difference in median post-operative chest tube output (780 mL vs. 850 mL; p = 0.88) and median post-operative PRBC transfusion (1 unit vs. 0 unit; p = 0.28) between the Hepcon and ACT groups, respectively.
      Conclusion: There was no difference in the composite outcome of thrombotic or hemorrhagic complications in patients monitored by Hepcon versus those monitored by ACT.
      Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Patrick Grady: Consultancy for Medtronic.
    • Contributed Indexing:
      Keywords: Antiphospholipid antibody syndrome; hemorrhagic disorders and therapies; thrombotic disorders
    • Publication Date:
      Date Created: 20230823 Date Completed: 20241001 Latest Revision: 20241001
    • Publication Date:
      20241001
    • Accession Number:
      10.1177/02676591231197990
    • Accession Number:
      37608561