Results: Within-system analysis showed strong linear correlation between paired measurements (R = 0.968-0.993). Subrange analyses were performed for low ACT values (results from T1, T5) and high ACT values (results from T2, T3, T4).
#Istat act kaolin plus#
The reproducibility, correlation, and differences in ACT values were assessed with two devices from each of the four ACT systems: Instrumentation Laboratory Hemochron Elite (Hmch), Medtronic HMS Plus (HMS), Abbott i-STAT, and Helena Abrazo. Samples were taken at five time points before (T1), after heparinization for CPB (T2, T3, T4), and after heparin reversal (T5). Methods: The study included 40 cardiac surgery patients. The objective of this study was to compare four ACT systems in cardiac surgery in terms of their reproducibility, agreement and potential clinical impact at relevant medical decision points. More research is needed regarding variability in vascular surgery and novel clot assessment techniques.īackground: In cardiac surgery on cardiopulmonary bypass (CPB), heparin anticoagulation is monitored by point-of-care measurement of activated clotting time (ACT). Conclusion: Sampling source should be kept consistent to facilitate effective haemostatic strategies. Novel clot assessment techniques have been validated in cardiac surgery, but measurements vary depending on sampling source. There were no studies directly examining ACT variability in vascular surgery. Inconsistent reports of variability were seen in cardiac surgery and cardiac catheterisation. Results: Fourteen studies were included in the systematic review. All studies reporting sampling source variability of ACT in cardiac surgery, vascular surgery and cardiac catheterisation were included. Methods: A comprehensive electronic search was conducted using PubMed, MEDLINE, Scopus, Cochrane database, and Google Scholar until 20th June 2020. It also examines the evidence surrounding novel clot assessment techniques and associated sampling variation. Objective: The systematic review aims to investigate the effect of sampling source on activated clotting time (ACT) measurement within cardiovascular surgery and cardiac catheterisation. Furthermore, our data question the reliability of the Hemochron in assessing adequacy of heparin anticoagulation monitoring for CPB. Conclusion: Currently used ACT point-of-care devices cannot be used interchangeably. 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.
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: -290-250s) and little concordance (kappa=0.368). Hemochron derived ACTs demonstrated worse linear correlation (r=0.782), larger bias with considerably broader LOA (-13.14s 95%LOA:-316.3-290s), and lesser concordance between parallel assays (kappa=0.554). Bias, as determined by Bland-Altman analysis, was low (-3.8s 95% limits of agreement (LOA): -77.8 -70.2s), and Cohen’s Kappa demonstrated good agreement (kappa=0.809). Results: 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. 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. Methods: 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. Background: 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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