• Philip M Jones, John M Murkin, Daniel Bainbridge, Wojciech Dobkowski, Christopher C Harle, Philip S Fernandes, and Bob Kiaii.
• Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, Ontario, Canada. philip.jones@lhsc.on.ca
• J. Cardiothorac. Vasc. Anesth.. 2011 Jun 1;25(3):415-8.

ObjectiveTo compare the kaolin-activated coagulation time (K-ACT) to the MAX-ACT for monitoring anticoagulation with bivalirudin in patients undergoing hybrid off-pump coronary artery revascularization procedures.DesignA prospective, observational study.SettingA cardiac surgical operating room of a university-affiliated hospital.ParticipantsTwelve patients undergoing off-pump coronary artery bypass graft surgery and percutaneous coronary intervention during the same procedure anticoagulated with bivalirudin to a target K-ACT of >300 seconds.InterventionAt baseline and at frequent intervals during anticoagulation, K-ACT and MAX-ACT assays were run contemporaneously, and the pairs of results were analyzed with descriptive statistics, by correlation analysis, and with Bland-Altman analysis.Measurements And Main ResultsThe MAX-ACT and K-ACT assays were highly correlated, but the MAX-ACT assay consistently reported significantly lower ACT values compared with the K-ACT. The mean bias (K-ACT minus MAX-ACT) was 94 seconds (limits of agreement, 51-138 seconds).ConclusionTo maximize patient safety, centers using bivalirudin for anticoagulation during cardiac surgical procedures need to be aware of the different performance characteristics of ACT assay subtypes.Copyright © 2011 Elsevier Inc. All rights reserved.

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