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Activated Coagulation Time and Hepcon Protamine Titration Device to Manage Unfractionated Heparin During Cardiopulmonary Bypass in a Hemophilia A Patient on Emicizumab.

Publication ,  Journal Article
Isaacs, J; Welsby, IJ; Schroder, JN; Onwuemene, OA
Published in: J Cardiothorac Vasc Anesth
November 2021

In the perioperative management of patients with hemophilia A, emicizumab prevents the accurate measurement of common clotting assays, including the activated clotting time (ACT), which is essential for high-dose heparin monitoring during cardiopulmonary bypass surgery. The authors describe the successful perioperative management of a hemophilia A patient on maintenance emicizumab who, following a non-ST myocardial infarction, underwent cardiopulmonary bypass grafting surgery with heparin monitoring using both the ACT and heparin levels from the Hepcon protamine titration device. Postoperatively, the patient was transitioned to recombinant factor VIII replacement therapy. In hemophilia A patients on emicizumab who require heparin titration on cardiopulmonary bypass surgery, the ACT, combined with Hepcon heparin levels, may be used to complete the surgery successfully without excessive bleeding or morbidity.

Duke Scholars

Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

November 2021

Volume

35

Issue

11

Start / End Page

3299 / 3302

Location

United States

Related Subject Headings

  • Whole Blood Coagulation Time
  • Protamines
  • Plant Preparations
  • Humans
  • Heparin
  • Hemophilia A
  • Cardiopulmonary Bypass
  • Anticoagulants
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Bispecific
 

Citation

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Isaacs, J., Welsby, I. J., Schroder, J. N., & Onwuemene, O. A. (2021). Activated Coagulation Time and Hepcon Protamine Titration Device to Manage Unfractionated Heparin During Cardiopulmonary Bypass in a Hemophilia A Patient on Emicizumab. J Cardiothorac Vasc Anesth, 35(11), 3299–3302. https://doi.org/10.1053/j.jvca.2020.08.058
Isaacs, James, Ian J. Welsby, Jacob N. Schroder, and Oluwatoyosi A. Onwuemene. “Activated Coagulation Time and Hepcon Protamine Titration Device to Manage Unfractionated Heparin During Cardiopulmonary Bypass in a Hemophilia A Patient on Emicizumab.J Cardiothorac Vasc Anesth 35, no. 11 (November 2021): 3299–3302. https://doi.org/10.1053/j.jvca.2020.08.058.
Isaacs, James, et al. “Activated Coagulation Time and Hepcon Protamine Titration Device to Manage Unfractionated Heparin During Cardiopulmonary Bypass in a Hemophilia A Patient on Emicizumab.J Cardiothorac Vasc Anesth, vol. 35, no. 11, Nov. 2021, pp. 3299–302. Pubmed, doi:10.1053/j.jvca.2020.08.058.
Journal cover image

Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

November 2021

Volume

35

Issue

11

Start / End Page

3299 / 3302

Location

United States

Related Subject Headings

  • Whole Blood Coagulation Time
  • Protamines
  • Plant Preparations
  • Humans
  • Heparin
  • Hemophilia A
  • Cardiopulmonary Bypass
  • Anticoagulants
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Bispecific