Proceedings

Activated Clotting Times versus Protocol Anticoagulation Management

¹ The Extracorporeal Circulation Technology Program, College of Allied Health Sciences
² The Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC 29425

^* Address correspondence to: James P. Dearing, B.S., C.C.P., College of Allied Health Sciences, Extracorporeal Circulation Technology Program, 171 Ashley Avenue, Charleston, SC 29425.

Abstract

This study compares the management of heparin and protamine administration during cardiopulmonary bypass by a protocol assuming a constant heparin degradation rate with management by an activated coagulation time dose-response method.

The charts of 648 adult patients operated on between January 1975 and December 31, 1980, were reviewed. In Group I patients, heparin was administered at a dosage of 2.5 mg/kg of body weight and supplemented by 50% of the loading dose at 2 hours and 25% each hour thereafter. Protamine was administered on a 1:1 basis according to an assumed heparin degradation rate of 0.4% per minute. In Group II patients, heparin and protamine doses were based upon activated coagulation time dose-response curves.

Data extracted from the charts included blood loss and replacement data, heparin and protamine doses, and coagulation profiles. The data from the two groups were compared and analyzed.

Group II patients received more heparin, but less protamine, had more complete heparin reversal, less post-operative bleeding, and required less blood or blood product replacement.