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  • Title: Platelet involvement in the activated coagulation time of heparinized blood.
    Author: Moorehead MT, Westengard JC, Bull BS.
    Journal: Anesth Analg; 1984 Apr; 63(4):394-8. PubMed ID: 6367544.
    Abstract:
    The activated coagulation time (ACT), commonly used during cardiopulmonary bypass (CPB), is assumed to measure only differences in heparin levels. Studies were undertaken to determine whether platelet activation/inhibition might also influence the test. When either the platelet inhibitor prostacyclin or the platelet activator adenosine diphosphate (ADP) was added to healthy donor blood containing 2 IU of heparin per ml, there was significant prolongation of the ACT (prostacyclin: mean prolongation, 60.6%; ADP: mean prolongation, 52.3%). In blood taken from the extracorporeal circuit of ten CPB cases, the prolongation with the platelet inhibitor carbacyclin, a prostacyclin analogue, was infinite. It is concluded that the ACT as used during CPB must be interpreted as a measure of both platelet procoagulant activity and heparin activity. Furthermore, this dual sensitivity, while fortuitous, is probably advantageous; patients with hyporeactive platelets will automatically receive less heparin.
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