Anticoagulation management for cardiopulmonary bypass using TEG® 6 s in a patient receiving both heparin and dabigatran

TL;DR

This paper discusses using TEG to manage anticoagulation during heart surgery in a patient taking both heparin and dabigatran.

Contribution

The study demonstrates how TEG can distinguish dabigatran effects from heparin to guide anticoagulation management during CPB.

Findings

TEG helped identify residual dabigatran effects despite prolonged ACT.

Idarucizumab reversed dabigatran, allowing proper heparin dosing for CPB.

TEG provides a more accurate assessment than ACT in patients on combined anticoagulants.

Abstract

It is difficult to evaluate adequate dose of heparin for cardiopulmonary bypass (CPB) by activated clotting time (ACT) in a patient receiving both heparin and dabigatran because dabigatran can also prolong ACT. We evaluated the effect of dabigatran by thromboelastography (TEG) to determine adequate heparin dose for CPB.

An 81-year-old woman receiving both heparin and dabigatran was scheduled for an emergency surgical repair of iatrogenic atrial septal perforation. Although ACT was prolonged to 419 s, we performed TEG to distinguish anticoagulation by dabigatran from heparin comparing R in CK and CHK. As the results of TEG indicated residual effect of dabigatran, we reversed dabigatran by idarucizumab and then dosed 200 U/kg of heparin to achieve adequate anticoagulation for CPB by heparin.

TEG could help physicians to determine need for idarucizumab and also an adequate dose of heparin to establish appropriate anticoagulation for CPB.

Figures