BackgroundThe authors assessed the heparin management testin vitroin volunteers andin vivoduring cardiopulmonary bypass.MethodsIn vitro, the heparin management test was analyzed for heparin levels between 0 and 6 IU/ml using variations in hematocrit, platelets, procoagulants, and storage time. Thein vivostudies consisted of two groups: In group I (cardiopulmonary bypass ≤ 90 min, n = 40), anticoagulation was performed according to the activated clotting time (with or without aprotinin); in group II (cardiopulmonary bypass ≥ 180 min, with aprotinin) included use (n = 10) and nonuse of coumadin (n = 10) and anticoagulation according to the automated heparin dose–response assay. Tests were performed in duplicate (whole blood, two heparin management test analyzers) and compared with anti-Xa activity (plasma).ResultsIn vitro, the results of the heparin management test (n = 1,070) correlated well with heparin concentration (r2= 0.98). Dilution and storage time did not affect the heparin management test; a hematocrit of 60% and reduced procoagulants (10%) prolonged clotting time.In vivo,the correlation (heparin management testvs.anti-Xa) was strong in group I (r2= 0.97 [with aprotinin] and 0.96 [without aprotinin]; n = 960) and group II without coumadin (r2= 0.89, n = 516). In group II with coumadin, the overall correlation was r2= 0.87 and 0.79 (n = 484), although the range varied widely (0.57–0.94, between-analyzer differences 0–47%).ConclusionsThe results of the heparin management test were influenced by hematocrit, plasma coagulation factors, and the heparin level, but not by use of aprotinin. The heparin management test provided reliable valuesin vitroin group I, and in group II without coumadin but was less reliable in group II with coumadin.