Category: Professional Posters
Purpose: Anticoagulation is a critical component of cardiopulmonary bypass (CPB) with heparin being the preferred anticoagulant. Sustained exposure to non-endothelial surfaces increases thromboembolic risk and increases heparin dosing requirements. Blood conservation guidelines recommend antithrombin III (ATIII) administration when there is difficulty in achieving goal anticoagulation with high-dose heparin. Heparin resistance occurs in approximately 20 percent of patients undergoing CPB. This difficulty in obtaining goal anticoagulation can frequently be alleviated by administration of fresh frozen plasma, if available, or ATIII.
Methods: The Pharmacy and Therapeutics Committee approved criteria for use of ATIII in heparin resistance in patients undergoing CPB. The criteria require the heparin dose to be greater than 600 units/kg and activated clotting time (ACT) to be less than 450 seconds. This study was a retrospective analysis of University of Iowa Hospitals and Clinics electronic medical records for patients with intraoperative orders for antithrombin III undergoing CPB. Objectives of the analysis were to assess whether ATIII utilization met P&T approved criteria with CPB (heparin dose greater than 600 units/kg and ACT less than 450 seconds), heparin dose at the time ATIII was ordered, and evaluate waste of ATIII doses that were ordered and not administered. IRB approval was obtained.
Results: The criteria were implemented in March 2017. There was a 65% increase in the monthly utilization of ATIII for CPB after criteria approval. Heparin dosing prior to ATIII administration was a mean of 442 units/kg with a median of 482 units/kg. Twelve percent of ATIII orders were compliant with the criteria.
Conclusion: Due to these undesired outcomes, new perfusion policies have been developed and are being implemented that requires heparin dosing to exceed 600 units/kg prior to ordering ATIII. In the future, post procedure implementation data will be compared with current data to assess for improvement in ATIII utilization.