Monitoring heparin anticoagulation and its neutralization

Heparin anticoagulation and its neutralization were monitored by three different techniques: a manual protamine titration, an automated activated coagulation time, and an automated protamine titration. All three techniques provided satisfactory information. The decision of which to use must be based on other considerations such as available manpower and cost of equipment. The effect of using the automated protamine titration test on heparin and protamine requirements, and on blood loss measured intraoperatively after bypass and in overnight chest bottle drainage in two groups of comparable patients undergoing coronary artery bypass operation was studied. The heparin requirements were similar (24,420 +/- 584 units, control group; 23,550 +/- 849 units, treatment group), but the protamine requirements were markedly different (429 +/- 14.7 mg, control; 258 +/- 10.4 mg, treatment; p < 0.05). There was no statistical difference in intraoperative blood loss or overnight chest bottle drainage.