[Control of temporary anticoagulation in extracorporeal circulation using activated coagulation time]

The customary use of standardized regimens for heparin anticoagulation and its neutralization by protamine in cardiopulmonary bypass may result in gross over- or underdosage of either substance with resulting clinical problems. Heparin and protamine doses, postoperative blood loss during the first 20 h and the need for bank blood in a group of 100 patients following a fixed heparin-protamine protocol were compared with another group of 106 cases with ACT-guided heparin and protamine dosage. In the ACT-group the mean heparin dose was 22.5% less (3.57 mg/kg and 4.60 mg/kg respectively) than in the standard group. Protamine doses fell by 58.5% from 5.11 mg/kg to 2.12 mg/kg in the ACT-group. The mean postoperative blood loss in the ACT-cases was 4.54 ml/kg/20h, 2.29 ml respectively 33.5% less than that of control group. The demand for bank blood in the ACT-group was 1.97 units opposed to 5.12 units in the standardized regimen group.