Comparison of two Activated Clotting Time targets during cardiac surgery with cardiopulmonary bypass

Gorter KAM, et al.

Journal of Cardiothoracic and Vascular Anesthesia. 2025. https://doi.org/[placeholder-link]

This multicenter randomized controlled trial evaluated whether a lower activated clotting time (ACT) target of ≥400 seconds is equivalent to a higher ACT target of ≥480 seconds in patients undergoing first-time elective cardiac surgery with cardiopulmonary bypass (CPB). Among 1,021 patients across four Dutch centers, red blood cell (PRBC) transfusion rates were found to be equivalent between the two ACT targets. While the lower ACT group had statistically less postoperative blood loss and slightly higher postoperative hemoglobin levels, the differences were deemed not clinically significant.

The study also found no meaningful differences in thromboembolic events or adverse outcomes between the two groups. These findings suggest that targeting an ACT of ≥400 seconds is safe and sufficient during modern cardiac surgery using biocompatible-coated CPB systems, and may help refine heparin management strategies without compromising patient outcomes.

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We thank the Journal of Cardiothoracic and Vascular Anesthesia for allowing us to share this important study. Their commitment to publishing rigorous, high-quality research continues to advance the field of cardiac and vascular anesthesia around the world.