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Protamine titration.

Fiona Newall1

  • 1Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Australia.

Methods in Molecular Biology (Clifton, N.J.)
|April 3, 2013
PubMed
Summary
This summary is machine-generated.

Protamine titration, the gold standard for unfractionated heparin (UFH) measurement, is not automated for clinical use. Current guidelines recommend correlating activated partial thromboplastin time (APTT) with anti-Xa or protamine titration assays for optimal UFH management.

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Area of Science:

  • Clinical Chemistry
  • Hematology
  • Pharmacology

Background:

  • Protamine titration is the established gold standard for measuring unfractionated heparin (UFH) in plasma.
  • However, its lack of automation limits its convenience for routine clinical management.
  • Historically, UFH levels of 0.2-0.4 U/ml correlated with APTT ratios of 1.5-2.5, indicating desirable safety and efficacy.

Purpose of the Study:

  • To review the role of protamine titration in unfractionated heparin (UFH) measurement.
  • To discuss the limitations of relying solely on activated partial thromboplastin time (APTT) for UFH management.
  • To highlight current recommendations for therapeutic UFH monitoring.

Main Methods:

  • Review of established clinical trials and guidelines regarding unfractionated heparin (UFH) monitoring.
  • Discussion of protamine titration methodology and its correlation with other assays.
  • Analysis of the relationship between UFH concentration and activated partial thromboplastin time (APTT) prolongation.

Main Results:

  • Protamine titration provides reliable and reproducible unfractionated heparin (UFH) measurements but is not readily automated.
  • Early studies established target ranges for UFH concentration (0.2-0.4 U/ml) correlating with APTT ratios (1.5-2.5).
  • Current recommendations advocate for correlating APTT with anti-Xa assay (0.35-0.7 U/ml) or protamine titration (0.2-0.4 U/ml) for therapeutic management.

Conclusions:

  • Protamine titration remains a gold standard but is impractical for routine clinical use due to lack of automation.
  • Managing unfractionated heparin (UFH) solely based on APTT prolongation is no longer considered ideal.
  • Current best practice involves correlating APTT with specific UFH levels measured by anti-Xa or protamine titration assays.