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Related Experiment Videos

Heparin rebound phenomenon--much ado about nothing?

P Martin1, F Horkay, N K Gupta

  • 1Department of Cardiothoracic Surgery, Killingbeck Hospital, Leeds, UK.

Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis
|April 1, 1992
PubMed
Summary

Heparin rebound after cardiac surgery does not significantly increase postoperative bleeding. This study found transient heparin levels in some patients, but their bleeding and coagulation profiles were similar to those without rebound, suggesting conservative protamine use.

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Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Pharmacology

Background:

  • Postoperative bleeding after open-heart surgery is often attributed to heparin rebound.
  • Empiric protamine sulfate administration is common for heparin rebound, but carries risks like pulmonary hypertension.
  • The clinical significance of heparin rebound and the necessity of aggressive protamine treatment remain unclear.

Purpose of the Study:

  • To investigate the efficacy of standard protamine sulfate dosing in reversing heparin.
  • To assess the clinical impact of transient heparin rebound on postoperative bleeding and coagulation.
  • To evaluate the necessity of additional protamine administration for heparin rebound.

Main Methods:

  • A study involving 42 patients undergoing open-heart surgery.

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  • Standard heparin bolus followed by an equivalent dose of protamine sulfate at the end of cardiopulmonary bypass.
  • Monitoring of heparin levels (Hepcon HMS), postoperative bleeding, thrombelastography, and coagulation screens.

    • Main Results:

    • Complete heparin neutralization was achieved in all patients 15 minutes post-protamine.
    • Transient detectable heparin levels (<1 hour) were observed in 14% of patients 2 hours later (heparin rebound).
    • No significant differences in 24-hour postoperative bleeding or coagulation profiles were found between patients with and without heparin rebound.

    Conclusions:

    • The clinical significance of heparin rebound following cardiac surgery is questionable.
    • Standard protamine dosing appears effective in neutralizing heparin, even with transient rebound.
    • Conservative administration of protamine sulfate for heparin rebound is recommended pending further elucidation.