Thromboprophylaxis With Heparin During Orthotopic Liver Transplantation: Comparison of Hepcon HMS Plus and Anti-Xa Assays for Low-Range Heparin

J Cardiothorac Vasc Anesth. 2017 Apr;31(2):575-581. doi: 10.1053/j.jvca.2016.08.001. Epub 2016 Aug 2.


Objectives: The purpose of this study was to compare the agreement between two heparin assays, Hepcon HMS plus/Kaolin-ACT and Anti-Xa, and their predictive power in detecting circulating heparin levels post-reperfusion of the liver graft when compared with thromboelastogram (TEG) r time ratio in patients undergoing orthotopic liver transplantation (OLT).

Design: Prospective, observational cohort study design.

Setting: Single center, university hospital.

Participants: Thirty-eight consecutive adults who had undergone liver transplant.

Interventions: None.

Measurements and main results: Paired arterial blood samples were collected before surgical incision, 5 minutes after administration of an average dose of 2,054±771 units of intravenous unfractionated heparin before caval cross-clamping, 5 minutes after portal reperfusion, 5 minutes after hepatic artery reperfusion, and 1 hour after hepatic artery reperfusion. The observations that heparin assay measurements were within the predetermined limits of agreement, strongly suggested the two heparin assays (Hepcon HMS plus and Anti-Xa assay) are interchangeable during prophylactic heparin dose therapy during OLT. Post-reperfusion, receiver operating characteristic curve analysis revealed high accuracy in measuring circulating heparin levels with both Anti-Xa and Hepcon HMS assays when compared with the TEG r time ratio assay.

Conclusions: The point-of-care Hepcon HMS plus/Kaolin-ACT (activated clotting time) assay appeared to be a reliable alternative to the more expensive and laboratory-required Anti-Xa assay in monitoring the response to intravenous heparin in patients undergoing OLT.

Keywords: Anti-Xa assays, throboelastograph (TEG); Hepcon HMS plus; heparin; liver transplantation.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / administration & dosage*
  • Anticoagulants / blood
  • Blood Coagulation Tests / methods
  • Cohort Studies
  • Factor Xa Inhibitors / administration & dosage*
  • Female
  • Heparin / administration & dosage*
  • Heparin / blood
  • Humans
  • Liver Transplantation / methods*
  • Male
  • Middle Aged
  • Plant Preparations / administration & dosage*
  • Pre-Exposure Prophylaxis / methods*
  • Prospective Studies
  • Thrombelastography / methods


  • Anticoagulants
  • Factor Xa Inhibitors
  • Hepcon
  • Plant Preparations
  • Heparin