Usefulness of hepcon® (Hemostasis management system) on postoperative bleeding after cardiac surgery: a retrospective study

Introduction Cardiac surgery with cardiopulmonary bypass(CBP) necessitates the most of the time an important anticoagulation by unfractionated heparin reversed by protamine at the end of the surgery. An inappropriate dose of heparin (HEP) or protamine (PROT) may increase bleeding, coagulation disorders, and postoperative inflammation. The Hepcon Hemostasis Management System®, Medtronic, Minneapolis, USA (HMS), is a system which enables a better adaptation for each patient by calculating HEP and PROT doses. But its impact on the bleeding is uncertain. The main objective of this study is to evaluate the impact of HMS on the postoperative bleeding. Methods It is a retrospective, comparative, non-interventional study. Inclusion criteria were an elective cardiac surgery with CBP between June 2016 and January 2018. Exclusion criteria were a CBP duration > 150 min, surgery for endocarditis, redo surgery, use of long term assistance or ECLS. Patients were separated into 2 groups: patients monitored with HMS and those monitored by Activated Clotting Time (ACT). Monitoring in HMS group included at least an HEP Dose Response test before CBP and an HEP PROT titration before PROT administration. During CPB theses patients were monitored by ACT. In ACT group the only coagulation monitoring was ACT, HEP dosage was weight dependent and PROT dose was calculated according to the HEP dose used. The main outcome was bleeding 12 hours after surgery (H12). Other outcomes were HEP and PROT doses, bleeding 3, 6 and 24 hours after surgery, transfusion rate, revision surgery rate, postoperative coagulation. Results 348 patients were included, 156 in HMS group and 192 in ACT group. In the HMS group doses of PROT (15583 ± 4653 UI vs. 23192 ± 6656UI, p Discussion HMS was associated with a reduce PROT dosage and initial bleeding, but the bleeding difference was not significant 12 hours after surgery.