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CANADIAN SURVEY ON ANTICOAGULATION FOR CARDIOPULMONARY BYPASS

Departments of Anesthesia, Universities of Toronto, Manitoba, Alberta, Western Ontario, and Dalhousie University

INTRODUCTION

Heparin is commonly used for anticoagulation during cardiopulmonary bypass (CPB). A survey of cardiac anesthesiologists and perfusionists in Canada was carried out to identify practice patterns in management of anticoagulation during CPB.

METHODS

The survey instrument was developed by Leo Pharma Inc. with input from members of the Cardiovascular and Thoracic section of the Canadian Anesthesiologists' Society, and the Canadian Society of Clinical Perfusion. The survey instrument comprised 17 closed and open-ended questions. It was mailed to all members of both societies in the fall of 2001.

RESULTS

A total of 64 responses were received from cardiac anesthesiologists, and 105 responses were received from perfusionists. All used heparin as their primary agent for anticoagulation for CPB with dosage based on body weight (300-400 U/kg). All respondents used the ACT for monitoring anticoagulation and 14% of respondents used additional techniques (such as PTT). The route of heparin administration was reported to be peripheral by 9 respondents, central/peripheral by 4, and all others administered heparin centrally. Protamine was used universally to reverse the effects of heparin at the end of surgery. The target ACT after heparin reversal was baseline (72% of respondents), baseline +10% (22%), or baseline +20% (6%). When asked what agent is used for patients with heparin induced thrombocytopenia, 10% of respondents specified danaproid, 7% ancrod and 7% hirudin.

DISCUSSION

This survey has helped to describe and summarize the most common current anticoagulation practices of cardiac anesthesiologists and perfusionists in Canada. Although some variability exists between centers, practice patterns are similar among most hospitals.

Acknowledgments

This project was supported by Leo Pharma Inc.

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