![]() Furthermore, our data question the reliability of the Hemochron in assessing adequacy of heparin anticoagulation monitoring for CPB.ĪCT Activated clotting time Anticoagulation Cardiopulmonary bypass Heparin Method comparison Protamine. Methods: The i-STAT G3+ (Abbott) was used as a reference analyzer to. Furthermore, while discrepancies in ACT between two parallel iSTAT assays showed little or no clinical relevance, deviations from parallel Hemochron assays and iSTAT versus Hemochron measurements revealed marked and sometimes clinically critical deviations.Ĭurrently used ACT point-of-care devices cannot be used interchangeably. Jooyoung Choa,b, Young Sam Kimc, Young Hwan Kima, Jae-Yeon Leea, In Cheol Baea. Overall, disconcordant results according to clinically predefined target values were more frequent with the Hemochron than i-STAT. Although demonstrating a fair linear correlation (r = 0.815), parallel measurements on different ACT-devices showed large bias (-20s 95% LOA: - 290-250 s) and little concordance (kappa = 0.368). Hemochron derived ACTs demonstrated worse linear correlation (r = 0.782), larger bias with considerably broader LOA (- 13.14 s 95%LOA:-316.3-290 s), and lesser concordance between parallel assays (kappa = 0.554). Bias, as determined by Bland-Altman analysis, was low (- 3.8 s 95% limits of agreement (LOA): - 77.8 -70.2 s), and Cohen's Kappa demonstrated good agreement (kappa = 0.809). Parallel i-STAT ACTs demonstrated a good linear correlation (r = 0.985). Measurements were compared between identical and different device types using linear regression, Bland-Altman analyses, and calculation of Cohen's kappa coefficient. At 3 hours post-admission, the sensitivity increased to 95 versus 100, and specificity was 100 versus 94.3 when compared to lab HsTnT. Blood samples from 30 patients undergoing cardiac surgery on CPB were assayed at specified steps (baseline, after heparin administration, after protamine administration) with four parallel measurements (two of each device type) using commercial Kaolin activated assays provided by the respective manufactures. At 0 hour, the POC TnI assay had a lower sensitivity (72.5 versus 97.5) and had almost equal specificity (99.24 versus 93.2) when compared to lab HsTnT assay. We evaluated the agreement of ACT assays using four parallel measurements performed on two commonly used devices each (i.e., two Hemochron Signature Elite (Hemochron) and two Abbott i-STAT (i-STAT) devices, respectively). However, concerns exist regarding reproducibility of ACT assays and comparability of devices. Since inadequate heparin anticoagulation and insufficient reversal can result in complications during cardiopulmonary bypass (CPB) surgery, heparin anticoagulation monitoring by point-of-care (POC) activated clotting time (ACT) measurements is essential for CPB initiation, maintainance, and anticoagulant reversal. ![]()
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