Heparinization during surgery

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In OPCAB surgery, the management of anticoagulation no longer needs to focus on the prevention of CPB-induced activation of the coagulation system with high dose heparin, but on the hypercoagulability, as thromboembolic and graft patency issues have been shown to occur in OPCAB patients during surgery. Therefore we still opt for an ACT of 400 seconds, demanding at least 3m/kg or more. The ACT is measured every 15 minutes and top-up doses of heparin are administered if below 400 seconds. Protamine is used at a 1 to 1 ratio (or 0.8 to 1).