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Anesth Analg 2005;101:308-314
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000173209.76933.BE

CARDIOVASCULAR ANESTHESIA

Monitoring Activated Clotting Time for Combined Heparin and Aprotinin Application: An In Vitro Evaluation of a New Aprotinin-Insensitive Test Using SONOCLOT

Michael T. Ganter, MD, DEAA*, Seraina Dalbert{dagger}, Kirk Graves, ECCP{ddagger}, Richard Klaghofer, PhD§, Andreas Zollinger, MD{dagger}, and Christoph K. Hofer, MD, DEAA{dagger}

*Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA; {dagger}Institute of Anesthesiology and Intensive Care Medicine and {ddagger}Division of Cardiac Surgery, Triemli City Hospital, Zurich, Switzerland; and §Department of Psychosocial Medicine, University Hospital Zurich, Zurich, Switzerland

Address correspondence and reprint requests to Christoph K. Hofer, MD, DEAA, Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland. Address e-mail to Christoph.hofer{at}triemli.stzh.ch.

The kaolin-based activated clotting time (ACT) is commonly used for monitoring heparin-induced anticoagulation alone and combined with aprotinin during cardiopulmonary bypass. However, aprotinin prolongs ACT measurements. Recently, a new so-called ‘aprotinin-insensitive‘ ACT test (SaiACT) has been developed for the SONOCLOT analyzer. In this study we evaluated and compared this new test for the SONOCLOT analyzer in vitro with an established kaolin-based ACT from HEMOCHRON (HkACT). Twenty-five patients undergoing elective valve surgery donated 80 mL of blood after induction of anesthesia. The blood was withdrawn in citrated tubes and processed to analyze effects of heparin (0, 1, 2, and 3 U · mL–1), aprotinin (0, 200 kIU · mL–1), and 25% hemodilution with calcium-free lactated Ringer’s solution on ACT measurements. A total of 400 blood samples were analyzed and ACT was measured in a wide, clinically relevant range in duplicate with SaiACT and HkACT. Addition of aprotinin to heparinized blood samples induced no significant changes of SaiACT measurements. By contrast, HkACT readings increased significantly: aprotinin prolonged HkACT in heparinized blood samples by 20% ± 37% (2 U · mL–1) and 24% ± 18% (3 U · mL–1), respectively, and in vitro hemodilution increased this effect.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.