• Ramona Nicolau-Raducu, Elise Occhipinti, Thomas Marshall, Joseph Koveleskie, Donald Ganier, Brian Evans, William Daly, Brian Fish, Ari J Cohen, Trevor W Reichman, David Bruce, Humberto Bohorquez, John Seal, Emily Ahmed, Ian Carmody, George Loss, Jonathan Rayburn, and Bobby Nossaman.
• Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA. Electronic address: rnicolauraducu@ochsner.org.
• J. Cardiothorac. Vasc. Anesth. 2017 Apr 1; 31 (2): 575-581.

ObjectivesThe purpose of this study was to compare the agreement between two heparin assays, Hepcon HMS plus/Kaolin-ACT and Anti-Xa, and their predictive power in detecting circulating heparin levels post-reperfusion of the liver graft when compared with thromboelastogram (TEG) r time ratio in patients undergoing orthotopic liver transplantation (OLT).DesignProspective, observational cohort study design.SettingSingle center, university hospital.ParticipantsThirty-eight consecutive adults who had undergone liver transplant.InterventionsNone.Measurements And Main ResultsPaired arterial blood samples were collected before surgical incision, 5 minutes after administration of an average dose of 2,054±771 units of intravenous unfractionated heparin before caval cross-clamping, 5 minutes after portal reperfusion, 5 minutes after hepatic artery reperfusion, and 1 hour after hepatic artery reperfusion. The observations that heparin assay measurements were within the predetermined limits of agreement, strongly suggested the two heparin assays (Hepcon HMS plus and Anti-Xa assay) are interchangeable during prophylactic heparin dose therapy during OLT. Post-reperfusion, receiver operating characteristic curve analysis revealed high accuracy in measuring circulating heparin levels with both Anti-Xa and Hepcon HMS assays when compared with the TEG r time ratio assay.ConclusionsThe point-of-care Hepcon HMS plus/Kaolin-ACT (activated clotting time) assay appeared to be a reliable alternative to the more expensive and laboratory-required Anti-Xa assay in monitoring the response to intravenous heparin in patients undergoing OLT.Copyright © 2017 Elsevier Inc. All rights reserved.

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