{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:29:31Z","timestamp":1777915771188,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,6,10]],"date-time":"2020-06-10T00:00:00Z","timestamp":1591747200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Amsterdam University Medical Centre"},{"DOI":"10.13039\/100004374","name":"medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006520","name":"edwards lifesciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006520","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006279","name":"st. jude medical","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006279","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Pulmonary endarterectomy requires cardiopulmonary bypass and deep hypothermic circulatory arrest, which may prolong the activated clotting time. We investigated whether activated clotting time\u2013guided anticoagulation under these circumstances suppresses hemostatic activation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Individual heparin sensitivity was determined by the heparin dose\u2013response test, and anticoagulation was monitored by the activated clotting time and heparin concentration. Perioperative hemostasis was evaluated by thromboelastometry, platelet aggregation, and several plasma coagulation markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Eighteen patients were included in this study. During cooling, tube-based activated clotting time increased from 719 (95% confidence interval\u2009=\u2009566-872\u2009seconds) to 1,273 (95% confidence interval\u2009=\u20091,136-1,410\u2009seconds; p\u2009&lt;\u20090.01) and the cartridge-based activated clotting time increased from 693 (95% confidence interval\u2009=\u2009590-796\u2009seconds) to 883 (95% confidence interval\u2009=\u2009806-960\u2009seconds; p\u2009&lt;\u20090.01), while thrombin\u2013antithrombin showed an eightfold increase. The heparin concentration showed a slightly declining trend during cardiopulmonary bypass. After protamine administration (protamine-to-heparin bolus ratio of 0.82 (0.71-0.90)), more than half of the patients showed an intrinsically activated coagulation test and intrinsically activated coagulation test without heparin effect clotting time &gt;240\u2009seconds. Platelet aggregation through activation of the P2Y12 (adenosine diphosphate test) and thrombin receptor (thrombin receptor activating peptide-6 test) decreased (both \u221233%) and PF4 levels almost doubled (from 48 (95% confidence interval\u2009=\u200942-53\u2009ng\/mL) to 77 (95% confidence interval\u2009=\u200971-82\u2009ng\/mL); p\u2009&lt;\u20090.01) between weaning from cardiopulmonary bypass and 3\u2009minutes after protamine administration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study shows a wide variation in individual heparin sensitivity in patients undergoing pulmonary endarterectomy with deep hypothermic circulatory arrest. Although activated clotting time\u2013guided anticoagulation management may underestimate the level of anticoagulation and consequently result in a less profound inhibition of hemostatic activation, this study lacked power to detect adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0267659120928682","type":"journal-article","created":{"date-parts":[[2020,6,11]],"date-time":"2020-06-11T00:48:02Z","timestamp":1591836482000},"page":"87-96","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Anticoagulation management during pulmonary endarterectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest"],"prefix":"10.1177","volume":"36","author":[{"given":"Dennis","family":"Veerhoek","sequence":"first","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurentius JM","family":"van Barneveld","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renard G","family":"Haumann","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne K","family":"Kamminga","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander BA","family":"Vonk","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christa","family":"Boer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petr","family":"Symersky","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,6,10]]},"reference":[{"key":"bibr1-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1177\/1089253214536621"},{"key":"bibr2-0267659120928682","first-page":"347","volume":"68","author":"Klok FA","year":"2010","journal-title":"Neth J Med"},{"key":"bibr3-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201509-620AS"},{"key":"bibr4-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1016\/j.drudis.2014.04.001"},{"key":"bibr5-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.114.304404"},{"key":"bibr6-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1177\/1089253214537688"},{"key":"bibr7-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3182354b7e"},{"key":"bibr8-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1186\/1477-9560-1-3"},{"key":"bibr9-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)41499-2"},{"key":"bibr10-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)41500-6"},{"key":"bibr11-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(10)63676-4"},{"key":"bibr12-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2016.07.002"},{"key":"bibr13-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2015.03.005"},{"key":"bibr14-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1177\/108925320500900105"},{"key":"bibr15-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2012.03.011"},{"key":"bibr16-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31827e4e62"},{"key":"bibr17-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1017\/S0265021507000592"},{"key":"bibr18-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/85.6.896"},{"key":"bibr19-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1159\/000071636"},{"key":"bibr20-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2009.11.023"},{"key":"bibr21-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1160\/TH15-08-0687"},{"key":"bibr22-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1594.2000.06340.x"},{"key":"bibr23-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0689"},{"key":"bibr24-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2008.03.001"},{"key":"bibr25-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1186\/s12959-014-0031-z"},{"key":"bibr26-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000064328.97941.FC"},{"key":"bibr27-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e31817ee955"},{"key":"bibr28-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31827cee88"},{"key":"bibr29-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199810000-00008"},{"key":"bibr30-0267659120928682","doi-asserted-by":"publisher","DOI":"10.3109\/14017431.2015.1099720"},{"key":"bibr31-0267659120928682","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.01.023"},{"key":"bibr32-0267659120928682","first-page":"88","volume":"32","author":"Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) the European Association of Cardiothoracic Anaesthesiology (EACTA)","year":"2017","journal-title":"J Cardiothorac Vasc Anesth"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0267659120928682","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0267659120928682","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0267659120928682","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:29:13Z","timestamp":1777656553000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0267659120928682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,10]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1177\/0267659120928682"],"URL":"https:\/\/doi.org\/10.1177\/0267659120928682","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,10]]}}}