Correlations between activated clotting time values and heparin concentration measurements in young infants undergoing cardiopulmonary bypass.

Background: Monitoring heparin concentration along with the activated clotting time (ACT) may provide a more accurate guide for the administration of heparin to infants during cardiopulmonary bypass (CPB). However, standard laboratory assays of heparin concentration (antifactor Xa heparin concentration) require plasma instead of whole blood, and results are not immediately available to clinicians. Alternatively, measurements of whole blood heparin concentration may be performed at the bedside using an automated protamine titration device, the Hepcon instrument (Hepcon Hemostasis Management System Plus; Medtronics, Minneapolis, MN).

The impact of aprotinin on postoperative renal dysfunction in neonates undergoing cardiopulmonary bypass: a retrospective analysis.

Background: Recent concern about the safety of aprotinin administration to adults has led to its suspension from worldwide markets. However, few studies have examined its safety in pediatric patients. Studies in children evaluating aprotinin's safety have been hindered by the heterogeneity of pediatric patients and the inconsistency of clinical protocols.

A comparison of heparin management strategies in infants undergoing cardiopulmonary bypass.

Background: Recent investigations in adult patients have suggested that a heparin concentration-based anticoagulation protocol for heparin administration during cardiopulmonary bypass (CPB) significantly reduced hemostatic activation when compared with standard weight-based heparin doses. Reductions in hemostatic activation during CPB could be particularly beneficial in pediatric patients in whom CPB-related coagulation issues are complex and influenced by many variables. However, information regarding heparin levels during CPB and their correlation to hemostatic activation is lacking in children.