The standard point-of-care Hemochron Jr. ACT+ test in monitoring heparin administration for cardiopulmonary bypass in severe factor XII deficiency
Erkinaro, Tiina; Moilanen, Janne; Lahtinen, Jarmo; Mosorin, Martti; Savolainen, Eeva-Riitta (2022-06-01)
Erkinaro, T., Moilanen, J., Lahtinen, J., Mosorin, M., & Savolainen, E.-R. (2022). The standard point-of-care hemochron jr. Act+ test in monitoring heparin administration for cardiopulmonary bypass in severe factor xii deficiency. Journal of Cardiothoracic and Vascular Anesthesia, 36(7), 2031–2034. https://doi.org/10.1053/j.jvca.2021.05.021
© 2021 The Author(s). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://urn.fi/URN:NBN:fi-fe2022102763551
Tiivistelmä
Abstract
Coagulation factor XII (FXII) is a plasma serine protease that belongs to the contact activation complex responsible for initiating the intrinsic coagulation pathway. FXII deficiency is a rare congenital disorder that is not associated with an increased tendency for bleeding. However, as contact activation is impaired in FXII deficiency, both the celite- and kaolin-initiated activated clotting time (ACT) measurements are prolonged markedly, which poses a challenge for anticoagulation monitoring in patients undergoing cardiac surgery. The authors successfully have used the standard Hemochron Jr. ACT+ test, which is activated by silica and phospholipid in addition to kaolin, to monitor anticoagulation for cardiopulmonary bypass in two patients with severe FXII deficiency. The ACT+ test showed low baseline values, increased adequately in response to heparin, and decreased to baseline after protamine. Importantly, there was no abnormal intra- or postoperative bleeding nor any thrombotic complications. Furthermore, in vitro dose-response ACT+ testing of FXII-deficient blood with increasing heparin concentrations supports the use of ACT+ in FXII deficiency.
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