Possible Heparin Reactivity Issue Causing Discrepant ACT results in Cath Lab
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Our cardiologists have told us that the ACT results on the i-STAT are discrepant, but then mentioned that there was also a possible problem with the reactivity of the heparin being used nationwide. Of course, they couldn't tell us which patients were involved. We're having them document the lot number of heparin that is being used, in addition to notifying us when the situation occurs.
Has anyone heard of any problems with heparin reactivity or had any problem with discrepant ACT testing on the i-STAT recently?
Thanks!
Linda
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What is their basis for this statement? Has Abbott Point of Care been notified?
Could it be heparin resistance in the patient so that the results aren't clinically correlating with the ACT obtained?
Could this have to do with the heparin reformulation from 2009? I realize that is 10 years ago, but perhaps some are just catching up with this.
https://www.medscape.com/viewarticle/709861
We notified Abbott of the last discrepancy that we knew about in July 2019 and Abbott did not find anything amiss with the ACT cartridge lot number that we were using at the time. Unfortunately, the cardiologists have not identified any specific patients since then that have had this issue even though they say the problem is ongoing.
They believe that the ACT is not increasing the correct amount (or their expected amount) after heparin administration.
Hi Linda,
Just a thought. Sometime in 2014/15, after we switched to istat ACT, one the EP Lab RNs commented that patients that were taking Pradaxa (I think), needed almost
3 X as much heparin to reach ACT targets. I think it’s use was rapidly decreased because it was twice a day dosing so most patients were on other similar medications. He has since retired so I can’t ask him which med it was for sure. I just know it was twice
a day and these were EP lab (Afib?) patients.
I hope that helps,
Sara
We experienced this in our hospital and it was determined to be the heparin. Apparently the regular source of heparin had to quit production due the pigs used
to produce the heparin contactedthe swine flu. The heparin is coming from a different country (India I believe). The physicians were not getting the increase in ACT results as expected per the administered dose which led to the investigation.
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How long ago did you have this issue? Also, what was your ACT test method?
Hi,
I hope this is not an issue in the future, especially if they start sourcing heparin from other sources and the pharmacies not letting us know that the heparin supply is changing.
https://www.bloomberg.com/news/articles/2019-11-11/deadly-pig-disease-sparks-fear-of-heart-drug-shortage-quicktake
Cath Lab brought it my attention about 2 weeks ago. We use the ACT K
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are the intended recipient, further disclosures are prohibited without proper authorization. If you are not the intended recipient, any disclosure, copying, printing, or use of this information is strictly prohibited and possibly a violation of federal or
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Hi Cheryl,
Is this a recent development?
Sara
It was brought to my attention approximately 2 weeks ago on November 22nd
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are the intended recipient, further disclosures are prohibited without proper authorization. If you are not the intended recipient, any disclosure, copying, printing, or use of this information is strictly prohibited and possibly a violation of federal or
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I had this same issue early this year. I had a locum physician complain that our ACT results were not accurate. He sent a complaint over to me. Upon looking into it more-- I discovered other physicians had felt the same way but did not communicate this to me. We use the GEM PCL plus (I know it is very old- not made anymore). So I had the company send me in another of the same instrument. We did a comparison study- running patients on both analyzers. This study came out nearly perfect. The Correlation Coefficient was 0.96. Still-- I had more complaints that the ACT results were not going up as it should with heparin administration. This time I got a bottle of heparin from our pharmacy and did a dilution study with whole blood. My study also worked great. The ACT results trended up with the heparin dosage just as it should. Once I sent this out to the physicians they have since not said anything and have concluded it must be due to the heparin and not the analyzer. Up until now I didn't even know about the change in our countries source of heparin that was mentioned above. If you want to see it I can send you my study results.
Thanks for the info! I'd love a copy of your study.
Thank you for the information, Ashlee. We would love to see a copy of your study. Please send to sclark@mercydesmoines.org.
What is your email Linda?