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Can we rely on arterial line sampling in performing activated plasma thromboplastin time after cardiac surgery?

Published online by Cambridge University Press:  23 December 2004

A. Alzetani ,
H. A. Vohra  and
R. L. Patel
A. Alzetani
Affiliation:
University Hospitals Coventry and Warwickshire NHS Trust, Department of Cardiothoracic Surgery, Walsgrave Hospital, Coventry, UK
H. A. Vohra
Affiliation:
University Hospitals Coventry and Warwickshire NHS Trust, Department of Cardiothoracic Surgery, Walsgrave Hospital, Coventry, UK Present post: Clinical Research Fellow, Cardiac Surgery, University Hospitals Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
R. L. Patel
Affiliation:
University Hospitals Coventry and Warwickshire NHS Trust, Department of Cardiothoracic Surgery, Walsgrave Hospital, Coventry, UK
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Abstract

Summary

Background and objective: Arterial catheters are routinely used to sample blood for clotting studies in most cardiothoracic intensive care units. The clotting profile in surgical bleeding after cardiac surgery influences further management. Aspiration and discard of a certain amount of blood from the line, prior to sampling, are assumed to clear heparin contamination. We have investigated this assumption through analysis of the clotting profile by simultaneous arterial line and peripheral venous samples.

Methods: The morning following cardiac surgery, simultaneous arterial line and peripheral venous blood samples were taken for activated plasma thromboplastin time (APTT) ratio and international normalized ratio (INR) in 49 randomly selected patients. Also, a thromboelastogram analysis (TEG) (n = 7) was made. A survey of 22 UK cardiothoracic intensive care units was carried out to determine the practice for the withdrawal of blood for clotting studies.

Results: The median arterial APTT ratio value was 1.32 ± 0.52 as compared to the median peripheral APTT ratio value which was 1.1 ± 0.24 (P < 0.001). INR values were statistically similar by both routes. Heparin contamination was confirmed by TEG which revealed that the R-value for arterial catheter blood samples without heparinase in the cup was higher (406.00 ± 64.44 s) compared with the value for arterial samples with heparinase in the cup (318.28 ± 47.26 s, P < 0.05). The survey of 22 UK cardiothoracic intensive care units showed that heparinized arterial lines were by far the commonest ports used for blood withdrawal for the measurement of APTT ratio results.

Conclusions: Samples withdrawn from heparinized arterial lines cannot be relied upon for APTT ratio results.

Keywords

BLOOD COAGULATION TESTS, partial thromboplastin timeTHROMBOELASTOGRAPHYCATHETERS, INDWELLING, arterial
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 5 , May 2004 , pp. 384 - 388
Copyright
2004 European Society of Anaesthesiology

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