A Berlis1, M Schumacher. 1. Sektion Neuroradiologie, Radiologische Universitätsklinik Freiburg i. Br. Schmid-Berlis@t-online.de
Abstract
PURPOSE: To evaluate the effect of anticoagulation control by bedside ACT during interventional neuroradiological procedures with intraarterial heparin application. MATERIALS AND METHODS: The study included 168 patients with intraarterial anticoagulation. Depending on the expected duration of the intervention and the body weight, a heparin dose of 5000 i.u. (70 patients) or 7500 i.u. (98 patients) was given through the catheter. The clotting time was measured with the Hemochrom 401 (Fa. Fresenius). RESULTS: The effect of anticoagulation with heparin was measurable a few minutes after administration. Within the first 20 minutes the ACT increased about two times above the normal ACT from 156.1 +/- 26.1 (5000 i.u. heparin) to 296 +/- 58.0 and from 146.5 +/- 26.3 (7500 i.u. heparin) to 317.2 +/- 72.0. Additional administration of 2500 i.u. heparin was necessary in 16 patients. An ACT monitored neutralisation with protamine hydrochloride took place in 15 patients with high ACT values at the end of the intervention. Three thromboembolic events and one bleeding complication occurred during the interventions. CONCLUSIONS: (1) The ACT is a useful and readily available parameter to monitor the anticoagulation status of patients in the interventional suits. (2) ACT detects heparin nonresponders. (3) Exact monitoring of heparin administration and neutralisation with protamine hydrochloride is helpful in preventing thromboembolic events and bleeding complications.
PURPOSE: To evaluate the effect of anticoagulation control by bedside ACT during interventional neuroradiological procedures with intraarterial heparin application. MATERIALS AND METHODS: The study included 168 patients with intraarterial anticoagulation. Depending on the expected duration of the intervention and the body weight, a heparin dose of 5000 i.u. (70 patients) or 7500 i.u. (98 patients) was given through the catheter. The clotting time was measured with the Hemochrom 401 (Fa. Fresenius). RESULTS: The effect of anticoagulation with heparin was measurable a few minutes after administration. Within the first 20 minutes the ACT increased about two times above the normal ACT from 156.1 +/- 26.1 (5000 i.u. heparin) to 296 +/- 58.0 and from 146.5 +/- 26.3 (7500 i.u. heparin) to 317.2 +/- 72.0. Additional administration of 2500 i.u. heparin was necessary in 16 patients. An ACT monitored neutralisation with protamine hydrochloride took place in 15 patients with high ACT values at the end of the intervention. Three thromboembolic events and one bleeding complication occurred during the interventions. CONCLUSIONS: (1) The ACT is a useful and readily available parameter to monitor the anticoagulation status of patients in the interventional suits. (2) ACT detects heparin nonresponders. (3) Exact monitoring of heparin administration and neutralisation with protamine hydrochloride is helpful in preventing thromboembolic events and bleeding complications.