Table E5.
Anticoagulation and blood-management practices among low- and high-performing Michigan versus non-Michigan centers
| Variables | Michigan centers |
Michigan centers |
P value | Non-Michigan centers |
Non-Michigan centers |
P value |
|---|---|---|---|---|---|---|
| Lowest center tercile of agreed-upon cardiotomy suction | Highest center tercile of agreed-upon cardiotomy suction | Lowest 2 cardiotomy suction performing centers | Highest 2 cardiotomy suction performing centers | |||
| Centers | 10 | 11 | 2 | 2 | ||
| Patients | 2620 | 4116 | 380 | 1040 | ||
| Heparin management | ||||||
| Method of determining initial heparin dose | .037 | <.0001 | ||||
| Fixed weight-based | 2094 (80.5) | 3388 (82.6) | 0 (0) | 353 (34.1) | ||
| Heparin dose response | 506 (19.5) | 716 (17.5) | 379 (100.0) | 681 (65.9) | ||
| Anticoagulation monitoring | ||||||
| Activated clotting time | 2548 (99.7) | 4104 (99.7) | .96 | 207 (54.5) | 1034 (99.4) | <.0001 |
| Heparin concentration | 79 (3.1) | 214 (5.2) | <.0001 | 379 (99.7) | 683 (65.7) | <.0001 |
| PT/PTT | 0 (0) | 0 (0) | – | 0 (0) | 0 (0) | – |
| Other | 2 (0.1) | 2 (0.05) | .63 | 0 (0) | 681 (65.5) | <.0001 |
| Coagulation monitoring | ||||||
| No | 1609 (63.0) | 2930 (71.2) | <.0001 | 375 (98.7) | 200 (19.2) | <.0001 |
| Yes, before CPB | 0 (0) | 823 (20) | <.0001 | 0 (0) | 704 (67.7) | <.0001 |
| Yes, during CPB | 0 (0) | 304 (7.4) | <.0001 | 0 (0) | 5 (0.5) | .18 |
| Yes, after CPB cessation | 416 (16.3) | 758 (18.4) | .026 | 0 (0) | 2 (0.2) | .39 |
| Hematocrit | ||||||
| Nadir on CPB | 24.3 [21.0, 28.0] | 26.1 [23.0, 30.0] | <.0001 | 27.0 [24.0, 30.5] | 26.5 [23.7, 30.0] | .25 |
| Before first RBC transfusion | 19.0 [17.0, 22.0] | 21.0 [19.0, 23.0] | <.0001 | 21.00 [19.0, 22.0] | 21.0 [19.0, 22.0] | .90 |
| Before second RBC transfusion | 20.0 [19.0, 23.0] | 21.0 [19.0, 23.0] | .24 | 21.00 [20.0, 22.0] | 21.0 [20.0, 22.0] | .49 |
| Red cell transfusion | .051 | .76 | ||||
| 0 | 4 (1.3) | 0 (0) | 0 (0) | 0 (0) | ||
| 1-2 | 251 (80.2) | 313 (78.5) | 22 (73.3) | 42 (76.4) | ||
| ≥3 | 58 (18.5) | 86 (21.6) | 8 (26.7) | 13 (23.6) | ||
| Protamine dosing, mg | 300.0 [250.0, 350.0] | 250.0 [250.0, 350.0] | <.0001 | 290.0 [225.0, 350.0] | 250.0 [200.0, 250.0] | <.0001 |
| Method for calculating initial protamine dose | <.0001 | <.0001 | ||||
| Fixed dose | 51 (2.0) | 71 (1.7) | 0 (0) | 2 (0.2) | ||
| Heparin protamine titration | 517 (19.9) | 266 (6.5) | 379 (100.0) | 678 (65.6) | ||
| Ratio dose of heparin given | 2030 (78.1) | 3637 (88.6) | 0 (0) | 354 (34.2) | ||
| Other | 2 (0.1) | 130 (3.2) | 0 (0) | 0 (0) | ||
| Non-RBC transfusion (amount in units) | ||||||
| In prime | ||||||
| Fresh-frozen plasma | 0.0 [0.0, 0.0] | 0.0 [0.0, 0.0] | .073 | 0.0 [0.0, 0.0] | 0.0 [0.0, 0.0] | – |
| During CPB | ||||||
| Platelets | 0.0 [0.0, 0.0] | 0.0 [0.0, 0.0] | .098 | 0.0 [0.0, 0.0] | 0.0 [0.0, 0.0] | .32 |
| Fresh-frozen plasma | 0.0 [0.0, 0.0] | 0.0 [0.0, 0.0] | .82 | 0.0 [0.0, 0.0] | 0.0 [0.0, 0.0] | .32 |
| Non-CPB | ||||||
| Platelets | 1.0 [1.0, 2.0] | 1.0 [1.0, 2.0] | .96 | 1.0 [1.0, 2.0] | 1.0 [1.0, 2.0] | .73 |
| Fresh-frozen plasma | 2.0 [1.0, 2.0] | 2.0 [2.0, 2.0] | .0002 | 2.0 [2.0, 2.0] | 2.0 [2.0, 2.0] | .13 |
PT/PTT, Prothrombin time/partial thromboplastin time; CPB, cardiopulmonary bypass; RBC, red blood cell.