Heparin Administration & ACT Results
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Over the last few weeks, we've had 3 cases in our Cath lab where the ACT value does not increase to a value expected by the cardiologists after heparin has been given. We use the i-STAT system for ACT testing. Different instruments have been used with the same sample and the same result is obtained, but that ACT result is lower than the cardiologists expect after heparin administration. We've notified the pharmacy of the problem and reported the issue to Abbott. Has anyone else had a problem with decreased potency of heparin lately?
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Hi Linda!
While there can be various reasons for what you are seeing, I find that it is most commonly due to the patient having an ATIII deficiency causing heparin resistance. I also find that my perfusionists in my CVOR are very well versed in this and can be utilized to help educate other users of ACT testing when this happens. It can be frustrating, but perfusion usually can pass on the techniques they use when they encounter this population of patients. Hope this is helpful!
Mary
Hi
I recently had the same complaint from our Cath Lab. We use i-STAT Celite. The complaints were made in late January but since seems to have resolved. We were using lot number R19303 at the time. Our Cath Lab was also experiencing increased error codes (all environment associated) due to the extreme cold in that room. They had just completed an OR renovation and have a new heating/cooling system. We chalked it up to the temp issue and moved the instruments outside the room. That coincided with a lot change. Just thought I would respond in case it turned out to be a lot issue or software upgrade issue. Good luck!
We have had the same issue with our hemochron elites.
What did your pharmacy have to say? There have been recent issues with heparin suppliers/different lots causing issues since the heparin activity may differ between suppliers/lots.
I have had this issue also with our Sig Elites. One thing we discovered was patients on DOACs took a substantial amount more heparin to start increasing their ACT than those on no anticoagulants or coumadin. It would be interesting to know if those 3 patients were also taking some type of DOAC.
Our pharmacy has not replied yet.
Carolyn - I'm unfamiliar with the term "DOAC".
The Cath Lab had 2 different types of Heparin in stock at the time and with the temp issues we were seeing it was dismissed as not related to the Heparin.
Direct Acting Oral Anticoagulants, such as Rivaroxaban, Dabigatran, and Eliquis.
Linda,
Didn't you talk about this back in Dec? You are still having issues from the physicians? I think someone had posted that the heparin was coming from a different country now so it may be made different causing the issues.
December title: Possible Heparin Reactivity Issue Causing Discrepant ACT results in Cath Lab
Yes, my director asked me to post again since we've had additional occurrences. Our pharmacy said that the heparin distributor has not changed in years so the heparin is not the problem. I'm hoping that they are looking into it again.
Did you get a copy of the Heparin/ACT study I did? Or did you do one yourself with your iSTAT? If you can show them it isn't the instrument and pharmacy says it isn't the heparin then it has to be individual patients' resistance to heparin.
Would you mind sending the study again? We believe pharmacy didn't take the issue very seriously in December thinking it was our instrument. We may do a study this time though. Thanks again!
It is on here under the file cabinet. Let me know if you can't find it.