{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:13:02Z","timestamp":1787735582837,"version":"build-2784847793"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac cardiovasc Surg"],"published-print":{"date-parts":[[2019,4]]},"abstract":"\n Introduction\u2003The recommended minimum activated clotting time (ACT) level for cardiopulmonary bypass (CPB) of 480\u2009seconds originated from investigations with bubble oxygenators and uncoated extracorporeal circulation (ECC) systems. Modern minimal invasive ECC (MiECC) systems are completely closed circuits containing a membrane oxygenator and a tip-to-tip surface coating. We hypothesized that surface coating and the \u201cclosed-loop\u201d design allow the MiECC to safely run with lower ACT levels and that an ACT level of 300\u2009seconds can be safely applied without thromboembolic complications. The aim of this study was to investigate the potential risks during application of reduced heparin levels in patients undergoing coronary surgery.<\/jats:p>\n Methods\u2003In this study, 68 patients undergoing coronary artery bypass grafting with MiECC were randomized to either the study group with an ACT target of 300\u2009seconds or the control group with an ACT of 450 seconds. All other factors of MiECC remained unchanged.<\/jats:p>\n Results\u2003The study group received significantly less heparin and protamine (heparin [international units] median [min\u2013max], Red_AC: 32,800 [23,000\u201351,500] vs. Full_AC: 50,000 [35,000\u201365,000] p\u2009<\u20090.001; protamine [international units], Red_AC: 18,000 [10,000\u201335,000] vs. Full_AC: 30,000 [20,000\u201345,000] p\u2009<\u20090.001). The ACT in the study group was significantly lower at the start of MiECC (mean\u2009\u00b1\u2009standard deviation: study group 400\u2009\u00b1\u2009112 vs. control group 633\u2009\u00b1\u2009177; p\u2009<\u20090.0001). Before termination of CPB the ACT levels were: study group 344\u2009\u00b1\u200960 versus control group 506\u2009\u00b1\u200980. In both groups, the values of the endogenous thrombin potential (ETP) decreased simultaneously. None of the study participants experienced thromboembolic complications.<\/jats:p>\n Conclusion\u2003Since no evidence of increased thrombin formation (ETP) was found from a laboratory standpoint, we concluded that the use of MiECC with a reduced anticoagulation strategy seems possible. This alternative anticoagulation strategy leads to significant reduction in dosages of both heparin and protamine. We can confidently move forward with investigating this anticoagulation concept. However, to establish clinical safety of ACT below 300\u2009seconds, we need larger clinical studies.<\/jats:p>","DOI":"10.1055\/s-0037-1609019","type":"journal-article","created":{"date-parts":[[2017,12,31]],"date-time":"2017-12-31T18:30:35Z","timestamp":1514745035000},"page":"191-202","source":"Crossref","is-referenced-by-count":23,"title":["Is 300 Seconds ACT Safe and Efficient during MiECC Procedures?"],"prefix":"10.1055","volume":"67","author":[{"given":"Adrian","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Perfusion, MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, Germany"},{"name":"Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Hausmann","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Schaarschmidt","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Perfusion, MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Szlapka","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Scharpenberg","sequence":"additional","affiliation":[{"name":"Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Eberle","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine, MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Hasenkam","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2017,12,31]]},"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0037-1609019.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,5]],"date-time":"2019-04-05T18:53:49Z","timestamp":1554490429000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0037-1609019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,31]]},"references-count":0,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2019,4,5]]},"published-print":{"date-parts":[[2019,4]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0037-1609019","relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"value":"0171-6425","type":"print"},{"value":"1439-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,31]]}}}