Cardiothoracic & vascular anesthesia
Protamine Dosing for Heparin Reversal after Cardiopulmonary Bypass: A Double-blinded Prospective Randomized Control Trial Comparing Two Strategies
Authors' conclusion
A 1:1 heparin ratio-based protamine dosing strategy compared to a fixed 250-mg dose resulted in the administration of a larger total dose of protamine but no difference in either the initial activated clotting time or the amount postoperative chest-tube bleeding.
Study context
- Population
- Elective adult cardiac surgical patients without preexisting coagulopathy or ongoing anticoagulation and calculated initial heparin dose ≥27,500 U
- Participants
- 62 vs 63
- Comparison
- Fixed-dose protamine vs ratio-based dose for heparin reversal after CPB
- Fixed-dosen = 62
- Ratio-based dosen = 63reference
- Primary endpoint
- Activated clotting time after initial protamine administration
Methodological detailsdouble-blinded, single-center
- Double-blinded
- Single-center
Primary result
As reported in the abstract
Postprotamine activated clotting time · after initial protamine administration
Mean postprotamine activated clotting time not different between groups
difference −2.0 s; 95% CI, −7.2 to 3.3 s; P = 0.47 (95% CI, P)
Secondary outcomes
| Outcome | Difference (50-mg vials) (95% CI) | P value | |
|---|---|---|---|
| Total protamine per case (50-mg vials)Less total protamine in the fixed-dose group | −2.1 (−2.4 to −1.8) | P < 0.0001 | |
| −3−2−101Difference, 50-mg vials (linear scale) |
Cumulative 24-h chest tube output
- No difference in cumulative 24-h chest tube output
- difference −77 ml; 95% CI, 220 to 65 ml; P = 0.28 (95% CI, P)
Original publication
Protamine Dosing for Heparin Reversal after Cardiopulmonary Bypass: A Double-blinded Prospective Randomized Control Trial Comparing Two Strategies. Anesthesiology. Published 10 October 2024. doi:10.
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