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Safety issues in heparin and protamine administration for extracorporeal circulation
1Department of Anesthesia, University of Pennsylvania School of Medicine, and The Children's Hospital of Philadelphia, USA.
Journal of Cardiothoracic and Vascular Anesthesia
|May 16, 1998
Summary
This study reviews heparin and protamine dosing strategies for cardiac surgery. An individualized unitized dosing system reduced heparin and protamine use, leading to less blood loss and fewer transfusions.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Traditional heparin and protamine dosing lacks individualization.
- Previous studies established specific activated coagulation time (ACT) values for monitoring.
- Heparin response curves and protamine titration systems have been proposed.
Purpose of the Study:
- To review past and current practices in heparin and protamine dosing.
- To present experience with a unitized dosing system for individualized heparin administration.
- To evaluate the impact of this system on patient outcomes in cardiac surgery.
Main Methods:
- Review of historical and current heparin and protamine dosing approaches.
- Clinical experience with the Celite activated coagulation time (ACT).
- Application of a unitized dosing system for individualized heparin and protamine administration in over 270 adult cardiac surgery patients.
Main Results:
- The unitized dosing system identified patient sensitivity/resistance to heparin, enabling precise dosing.
- Reduced heparin usage in short bypass runs and less protamine administration were observed.
- The system correlated with decreased blood loss and fewer transfusion requirements.
Conclusions:
- Individualized heparin and protamine dosing via a unitized system improves outcomes in cardiac surgery.
- Current data does not support maintaining heparin concentrations above 3 U/mL.
- The Celite ACT is unsuitable for monitoring heparin with aprotinin; kaolin ACT should be used instead.