Perfusion Insider Fall 2015

Individualized Heparin Management: Because ACT alone is no longer enough


When "Judy", a 68-year-old retired paralegal with multiple challenges, including diabetes, chronic renal disease and moderate anemia underwent a quadruple bypass, she was heparinized according to the hospital's protocol, using ACT to monitor and manage heparin levels throughout the procedure.

Although Judy is a fictional patient*, her story is based on actual test data, and reflects very real challenges perfusionists face today in managing heparin levels. Today's cardiac patients are complex patients. They're older and sicker, with multiple conditions and comorbidities, taking numerous medications and nutritional supplements — presenting real challenges around anticoagulation management. Further complicating matters, heparin potency can vary considerably. And institutions are closely scrutinizing the use of blood products, looking to minimize clinical and financial costs.

In this environment, the need for precise, individualized heparin management has become critical and ACT by itself is no longer enough.

Why you shouldn't ACT alone

In spite of her complex condition, Judy's surgery was uneventful. Nothing unexpected came up in the course of heparin dosing, managing and neutralizing, guided by ACT. But she began to bleed post-op, and ended up needing to be transfused, at considerable clinical and financial cost.

The question is, did ACT provide adequate visibility into the Judy's heparin concentration throughout the procedure? The answer is most likely not. Medications, supplements, comorbidities and other factors can cause significant differences in the way individual patients respond to heparin and ACT alone does not account for these differences.

That's where the HMS Plus System comes in. By providing greater visibility into patients' heparin concentration throughout the care continuum, the HMS Plus System allows for more precise management of each individual case, delivering significantly different — and better outcomes — than ACT alone1.

Experience the impact of IHM with the impACT interactive tool

You can walk through Judy's case–as well as the cases of three other patients with different conditions and challenges — using the impACT tool, an interactive experience created by Medtronic to show how the visibility the HMS Plus System provides can affect heparin management decisions and patient outcomes.


This is a fictional case based on observed data. The patient name, stats, health factors and procedure in this story are fictional; however, the diagnostic test results are representative examples of actual test data. The data was observed when comparing heparin levels during cardiac surgery with ACT alone and with Individualized Heparin Management with the HMS Plus Hemostasis System. The comparisons were done for evaluation purposes only. Patient transfusion data are actual.

This patient story is not intended to be a recommendation by Medtronic. It does not represent the professional opinion of any physician, practice, or practitioner. It is compiled and provided by Medtronic for general educational purposes only and should not be considered the exclusive source for this type of information. At all times, it is the professional responsibility of the practice or clinical practitioner to exercise independent judgment in a particular situation and treat patients based on their judgment and medical necessity. Results may vary.


Despotis GJ, "The Impact of Heparin Concentration and Activated Clotting Time Monitoring on Blood Conservation" J Thorac Cardiov Sur, 1995, Vol1 No 1: 46-54