![]() ![]() Without appropriate anticoagulation clot will start to form in the circuit within minutes of commencing bypass, with a high chance of a fatal event occurring. It is therefore mandatory to ensure that appropriate anticoagulation has been achieved for any form of extracorporeal circulation and any circumstance where foreign material, such as large-bore catheters, is introduced into the arterial side of the circulation for extended periods of time.Ĭonventional cardiopulmonary bypass (CPB) circuits are made up of several meters of plastic tubing, a plastic reservoir and a membrane oxygenator. In the absence of adequate anticoagulation, blood stasis or contact with artificial, non-biological surfaces is likely to lead to activation of the clotting cascade with potentially fatal consequences. KeywordsĪctivated clotting time, heparin monitoring, point of care, cardiology, anticoagulation, hemostasis AbbreviationsĪCT: Activated Clotting Time CBP: Cardiopulmonary Bypass POC: Point of Care ACT 2018 – Are there any lessons to be learned from the past? The lesson to be learned from the last 40 years is that clinicians’, laboratory staff’s and manufacturers’ approach to the ACT needs to become more collaborative, open and truly multidisciplinary in order to stand up to the level of scrutiny that is increasingly demanded in modern healthcare. Being mostly ‘clinician owned’ we have come to accept that, in the absence of a gold standard, there is no way to determine if any one of the commercially available devices measures a true ACT value. The ACT has gone unchallenged for a long time. Moreover, it is important to realize that there is no “gold standard” ACT method and therefore no “true” ACT. Furthermore, the target ACTs which are described in guidelines are mostly empiric or based on small-scale studies done with one or different POC ACT devices. Currently, there are several POC methods available for ACT measurement, however results obtained with different devices can vary substantially. Without appropriate anticoagulation clot will start to form during these procedures, with a high chance of a fatal event occurring. Today, ACT is the primary test for monitoring heparin activity in cardiac and vascular operating rooms, intensive care and hemodialysis units as well as in the catheter lab. It is over 50 years ago that Paul Hattersley first described the ACT and 40 years ago it was first used as a simple method of heparin management during extracorporeal circulation. In this review we summarize the current status of knowledge and outline future directions regarding the use of activated clotting time devices (ACT) for heparin monitoring. ![]()
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