Cardiothoracic & vascular anesthesia
Minimum protamine dose required to neutralize heparin in cardiac surgery: a single-centre, prospective, observational cohort study
Authors' conclusion
The protamine:heparin ratio required to neutralize residual unfractionated heparin (UFH) following CPB is variable. A protamine:heparin ratio of 0.3 was sufficient to neutralize UFH in some patients, while a ratio of 0.5 is sufficient to neutralize both residual anti-IIa and -Xa activity in most patients.
Study context
- Population
- Consecutive patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB)25 analysed
- Participants
- 28 patients
- Exposure
- Cumulative protamine doses of 150, 200, 250 and 300 mg after CPB
- Outcome
- Least protamine dose necessary to neutralize residual heparin after CPB (anti-IIa and anti-Xa activity)
Methodological detailssingle-centre, consecutive patients, Protamine given by infusion pump at 25 mg·min-1; samples before and after 150, 200, 250 and 300 mg
- Single-centre
- Consecutive patients
- Protamine given by infusion pump at 25 mg·min-1; samples before and after 150, 200, 250 and 300 mg
Main finding
As reported in the abstract
Complete neutralization at first sampling point (150 mg protamine; protamine:heparin ratio 0.3 [0.1])
8 out of 25
32%
Protamine:heparin ratio sufficient for neutralization in > 90% of patients
0.5
0.2
Observational data: associations, not effects.
Secondary outcomes
Post-CPB activated clotting time as surrogate for heparin neutralization
- Low to mid-range activated clotting time correlated well with anti-IIa and -Xa activity
Original publication
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