Table 2 Overview of peri-operative heparin dosages,ACT measurements and anticoagulation-/thrombosis prophylaxis strategy during admission

Day 1: Elective CABG with aortic valve replacement

 Baseline ACT level: 115 s, Target ACT: 480 s

  Anticoagulation and thrombosis prophylaxis pre-operative: Clopidogrel 75 mg/day, Nadroparin 2850 IU/day

Time

Administration

Dose

ACT (Sec)

11:44

Heparin

25.000 IU (352 IU/kg)

313

11:56

Heparin

20.000 IU (282 IU/kg)

200

12:13

Antithrombin

500 IU

180

12:34

Heparin (new batch)

30.000 IU (423 IU/kg)

12:36

Antithrombin

500 IU

310

Anticoagulation and thrombosis prophylaxis pre-operative post-operative: Clopidogrel 75 mg/day, Nadroparin 2850 IU/day, Acetylsalicylic acid 80 mg/day

Day 12 afternoon: Percutaneous coronairy intervention (PCI)

Target ACT: 220 s

Heparin 8.000 IU (112 IU/kg)

ACT 150

Heparin 5000 IU

Heparin 15.000 IU (211 IU/kg)

ACT 225

GPIIb-IIIa antagonists and intracoronary actilyse 15 + 50 + 35 (mg)

Anticoagulation and thrombosis prophylaxis pre-operative post PCI: Acetylsalicylic acid 80 mg/day, Prasugrel 10 mg/day, Enoxaparin 1 mg/kg twice daily

Day 12 night: Surgery tamponade

 Baseline ACT 128 s

Time

Administration

Dose

ACT (sec)

04:50

Heparin

75.000 IU (1057 IU/kg)

 > 999 ➔ 281 (05:57)

05:59

Heparin

25.000 IU (352 IU/kg)

439 (6:09)

06:14

Heparin

25.000 IU (352 IU/kg)

06:25

Heparin

25.000 IU

07:39

Protamine

300 mg

177 (07:49 h)