The Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), and the American Society of ExtraCorporeal Technology (AmSECT) have published new guidelines on anticoagulation during cardiopulmonary bypass (CPB).
Despite more than half century of “safe” CPB, practice in this area has been highly variable and this new guidance was developed to help address the gap in standardisation.
The recommendations focus on three main areas: heparin dosing and monitoring for initiation and maintenance of CPB; heparin contraindications and heparin alternatives; and reversal of anticoagulation during cardiac operations.
Amongst the individual recommendations is that clotting time should be measured and should demonstrate adequate anticoagulation before initiating heparin and at regular intervals during CPB. The guidelines also state that for patients with a diagnosis of heparin-induced thrombocytopenia and in need of an urgent CPB, anticoagulation with bivalirudin is a reasonable option.
“It is our hope that these guidelines will help clinicians practise consistent and safe anticoagulation and that there will be more standardisation in practice,” said lead author Dr Linda Shore-Lesserson. “Surgeons, anaesthesiologists, and perfusionists will better appreciate the science behind the practices that they conduct every day.”
The guidelines are published in The Annals of Thoracic Surgery.