INTRAOPERATIVE MONITORING OF DANAPAROID SODIUM ANTICOAGULATION DURINGCARDIOVASCULAR OPERATIONS

Purpose: Patients with cardiovascular disorders frequently need antico agulation for diagnostic studies, surgical procedures, and therapy. He parin-induced thrombocytopenia is a relatively common complication of heparin therapy that can result in thrombosis and subsequent limb loss or death, necessitating use of alternative anticoagulants. Methods: T wo patients who needed cardiac surgery had thrombocytopenia induced by exposure to heparin and heparin-coated tubing. Several assays were ex amined for their ability to monitor intraoperative anticoagulation of a factor Xa inhibitor, danaparoid sodium. Results: In vitro, celite an d kaolin activated clotting times and activated partial thromboplastin time were prolonged linearly in the presence of increasing concentrat ions of danaparoid sodium. Aprotinin did not alter the linearity of th e response but did alter its slope. In vivo, activated clotting times and activated partial thromboplastin time were insensitive to clinical ly significant changes in danaparoid sodium plasma levels during cardi opulmonary bypass. Correction in activated partial thromboplastin time lagged 2 hours behind clinically important changes in anti-factor Xa levels. Only anti-factor Xa levels were adequate to monitor intraopera tive danaparoid sodium levels. Conclusion: Anticoagulation for cardiop ulmonary bypass can be successfully performed with danaparoid sodium a nd intraoperative anti-factor Xa monitoring.