Cardiopulmonary Bypass Anticoagulation — FRCA Final MCQ
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Correct answer: A — 400 seconds
The correct answer is A: 400 seconds. The UK heparin sodium SmPC specifies an ACT range of 400–500 seconds during cardiopulmonary bypass, following an initial intravenous dose of 300 units/kg. An ACT of 280 seconds is therefore inadequate; bypass should not proceed until additional anticoagulation has been given and the ACT rechecked. An ACT of 300 seconds remains below the specified range. A target of 480 seconds is commonly used in cardiac centres and is prominent in the literature, but it is not the lower limit of the SmPC range asked for here. ACT results and thresholds are device- and protocol-dependent, so the applicable local protocol must be followed clinically. Values of 200 seconds and 600 seconds are respectively inadequate and unnecessarily above the stated range.
Reference: Wockhardt UK Ltd. Heparin sodium 1,000 I.U./ml solution for injection or concentrate for solution for infusion, Summary of Product Characteristics, section 4.2: cardiopulmonary bypass. 2018. https://www.medicines.org.uk/emc/product/1680/smpc