Does a delay in performing an activated clotting (ACT) test really matter? A study in nonheparinized blood and a single ACT machine

Abstract

Activating clotting time (ACT) is a point-of-care, blood clotting test used to monitor anticoagulation. Recently, institutional requirements have required that ACT testing be completed outside the operating room with trained, certified personnel other than anesthesia staff. For this reason, in this study, we looked at whether a delay in processing an ACT makes a significant difference to the ACT results. Twenty patients between 18 and 65 years of age consented to the study, each undergoing non-cardiac surgery, with no intraoperative administration of heparin. The study was approved by our Institutional Review Board. A blood sample was taken from the patient's arterial line in the operating room. Immediately afterward, 1 mL was placed into each of two ACT cartridges and the measurement was done in a Medtronic ACT2 machine. The first ACT value was 126.9 ± 14.5 seconds. The ACT value at ∼30 minutes was 108.3 ± 20.3 seconds (p < .0001). The time between the first and last measurements was 29.4 ± 3.0 minutes. The results suggest that the ACT values decrease over time between sampling all measurements. At ∼30 minutes, the ACT values average 15% less than the control measurements. Therefore, it would seem prudent to determine ACT values immediately in the operating room without any delay, using point-of-care testing.