Comparison of Point-of-Care Activated Clotting Time Systems Utilized in a Single Pediatric Institution

The ability to quickly and reliably monitor whole blood coagulation time is crucial for the safe management of patients undergoing heparin therapy. This is especially true in the settings of the operating room during cardiopulmonary bypass, the catheterization laboratory during an intervention, or the cardiac intensive care unit while on extracorporeal life support. Hemostasis is appropriately and most simply managed with point-of-care (POC) activated clotting time (ACT) testing at the bedside. Four different POC ACT testing systems are currently being used at our institution. These include the Medtronic HMS Plus Hemostasis Management System (HMS) (Medtronic Perfusion Systems, Minneapolis, MN), ACT Plus® Automated Coagulation Timer System (ACT Plus) (Medtronic Perfusion Systems, Minneapolis, MN), Hemochron® Signature Elite Whole Blood Microcoagulation System (Hemochron) (International Technidyne Corp, Edison, NJ), and i-STAT® Handheld and Test Cartridge Blood Analysis System (i-STAT) (Abbott Point of Care Inc., Princeton, NJ). Each system has a unique testing method, which we suspect produces substantial variations in ACT measurement.