Activated clotting time test alone is inadequate to optimize therapeutic heparin dosage adjustment during post-cardiopulmonary resuscitational extracorporeal membrane oxygenation (e-CPR)

Abstract

Background:

We conducted an observational study to evaluate the relationship between activated clotting time (ACT) and activated partial thromboplastin time (aPTT) tests, anticipating the possibility that the ACT will become a substitute test for the aPTT in post-CPR extracorporeal membrane oxygenation (e-CPR).

Patients and Methods:

Three hundred and fifteen paired ACT and aPTT samples were derived from 60 in-hospital e-CPR patients and were divided into three groups according to the observed ACT value: low level (ACT<170 s, Group A), intended target level (ACT 170–210 s Group B) and high level (ACT>210 s, Group C). The relationship of aPTT in each group was analyzed.

Results:

The mean ACT and aPTT values were 189.39 ± 48.27 s (IQR, 163–202) and 71.85 ± 45.32 s (IQR, 44.5–81.8), respectively. Although the observed mean ACT value of 189.39 s was similar to the intended mean target value of 190 s (p=0.823), the observed mean aPTT value (71.85 s) was significantly lower than the predicted mean target value (77.5 s, p=0.027). Despite the mean ACT values being significantly different in each group (p<0.0001), the mean aPTT values were not statistically different between Groups A and B (p = 0.317). Of the Group B samples (n = 139), only 31 samples (22.3%) met the optimal therapeutic aPTT range. Pearson’s correlation coefficient for Group B showed only a weak correlation between ACT and aPTT (r=0.177; p=0.037).

Conclusions:

Our study demonstrates that the ACT test alone does not seem to be enough to optimize therapeutic heparin dosage adjustment during e-CPR.

Keywords

ECMO PCPS ACT aPTT anticoagulation e-CPR CPR

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