Hemostasis management by use of Hepcon/HMS (TM): Increased bleeding without increased need for blood transfusion

Background: Extracorporeal circulation forces complete anticoagulation, mos t frequently achieved by complete heparinization. Activated clotting time ( ACT) is the gold standard for monitoring, although there is a lack of corre lation between heparin plasma level and ACT. Several systems for the estima tion of free heparin have been developed: in this study we focused investig ating on the influence of the Hepcon/HMS(TM) system on postoperative bleedi ng and transfusion requirements. Methods: 114 patients were randomly assign ed to one group monitored by use of Hepcon/HMS(TM) (group hepcon) and anoth er group by use of ACT (ACT group); 7 patients were excluded due to re-expl oration. 12 patients did not receive aprotinin; this part of the study was stopped early due to massive increased bleeding. 46 and 49 patients of grou ps hepcon and ACT, respectively, received aprotinin. Results: Using aprotin in, in group hepcon total administered heparin was elevated by 13% in contr ast to group ACT while administered protamine was reduced by 20%. The ratio of antagonization was 82 +/- 17% and 51 +/- 12 %, respectively. Coagulatio n parameters were not influenced except for increased postoperative ACT and PTT in the hepcon group. Bleeding of patients in that group was significan tly increased during the first 6 hours, which led to an increased autologou s retransfusion. Need for substitution of other blood components was not in creased postoperatively. Conclusions: Use of the Hepcon/HMS(TM)-system for monitoring of heparinization during extracorporeal circulation is possible without increased risk of thromboembolism. Postoperative blood loss was sli ghtly but significantly increased but there was no need For more heterogeno us transfusion.