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Anticoagulation & hemostasis
SOP » Anaesthesia protocol » Anticoagulation & hemostasis
Last modified on Tue 15 Jul 2014

The use of prophylactic antifibrinolytics is not standard at our institute.

In OPCAB surgery, the management no longer needs to focus on the prevention of CPB-induced activation of the coagulation system with high-dose heparin. However, we have not adapted the common tendency to reduce heparin doses to levels as low as 1 mg/kg for OPCAB. Instead, hypercoagulability has been shown to occur frequently in OPCAB patients and thromboembolic phenomena, including graft patency issues, remain an important concern. For that reason we still opt for heparin doses of 3 mg / kg to obtain an ACT of 400 seconds.

The ACT is measured every 15 minutes and top up doses of heparin are administered when ACT is < 400 sec. Protamin is used at a 1 to 1 ratio (or 0.8 to 1) for reversal of the heparin effect at the end of the anostomotic time.