Anticoagulation control with ACT (activated clotting time) during interventional neuroradiology.

Purpose: To evaluate the effect of anticoagulation control by bedside ACI d uring interventional neuroradiological procedures with intraarterial hepari n application. Materials and Methods: The study included 168 patients with intraarterial anticoagulation. Depending on the expected duration of the in tervention and the body weight, a heparin dose of 5000 IU (70 patients) or 7500 IU (98 patients) was given through the catheter. The clotting time was measured with the Hemochrom 401 (Fa. Fresenius). Results: The effect of an ticoagulation with heparin was measurable a few minutes after administratio n. Within the first 20 minutes the ACT increased about two times above the normal ACT from 156.1+/-26.1 (5000 IU heparin) to 296+/-58.0 and from 146.5 +/-26.3 (7500 IU heparin) to 317.2+/-72.0. Additional administration of 250 0 IU heparin was necassary 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 bleedi ng 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 no nresponders. (3) Exact monitoring of heparin administration and neutralisat ion with protamine hydrochloride is helpful in preventing thromboembolic ev ents and bleeding complications.