Post-Neutralisation Activated Clotting Time and Postoperative Transfusions in Cardiac Surgery Outcome

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Hematology

Background:

• Protamine neutralisation is critical after cardiopulmonary bypass to reverse heparin.
• Activated clotting time (ACT) monitoring guides protamine administration.
• Optimal ACT targets post-neutralisation for patient outcomes remain debated.

Purpose of the Study:

• To evaluate the impact of post-protamine neutralisation ACT values on postoperative outcomes in cardiac surgery.
• To compare outcomes between patients maintaining ACT within 10% of baseline versus those deviating.
• To assess effects on chest drain output, transfusion needs, and CICU stay.

Main Methods:

• Observational comparative study of 101 elective cardiac surgery patients.
• Patients categorized into two groups based on post-protamine ACT relative to baseline.
• Outcomes included chest drain output, transfusion requirements, CICU stay, and need for additional protamine.

Main Results:

• No significant differences observed in CICU stay, chest drain output, or transfusion rates between groups (p >0.05).
• Similar tranexamic acid use and postoperative reopening rates were noted.
• Baseline characteristics were comparable between the groups.

Conclusions:

• Maintaining ACT within 10% of baseline post-protamine neutralisation is associated with similar postoperative outcomes.
• This approach may allow for avoidance of aggressive protamine therapy while ensuring haemostasis.
• Further research could explore specific ACT thresholds for optimal patient management.