Neutralization of heparin after extracorporeal circulation

In a two group-study of patients with and without postoperative haemorrhagic diathesis after ECC tests were undertaken to ascertain whether a postoperative haemorrhagic diathesis after neutralization of Heparin is due to the use of protamine-chloride or stet to a preoperative existing disturbance of the coagulation system. At the end of the ECC, a strongly marked fibrinolysis has been found to take place, together with an increased turnover of coagulation factors i.e. DIC. These results indicate that we are not concerned with a primary fibrinolysis, which would be characterized by plasminaemia, but rather with a reactive fibrinolysis. This coagulation disturbance was more marked in the group with postoperative haemorrhagic diathesis and it became even more pronounced after neutralization with protamine-chloride. From the results we obtained in our tests, the bleeding which occurs after the neutralization of heparin with protamine-chloride can be explained by increased DIC. We think a so-called "heparin-rebound-effect" is improbable as a cause of this postoperative bleeding complication. When there is DIC at the end of the by-pass time, one should avoid neutralizing the heparin and continue the heparin treatment for the same reason.