Original Article

Low Dose Protamine for Heparin Reversal in 40 Consecutive Cardiopulmonary Bypass Patients

St. Francis Medical Center, Monroe, LA

^* Direct communications to: George E. Cimochowski, M.D., 141 DeSiard, Suite 410, Monroe, LA 71201

Abstract

(J. Extra-Corpor. Technol. 19[3] p. 348-351 Fall 1987, 13 ref.) Reversal of systemic heparinization in cardiac surgery has been a subject of controversy for some time. For reversal, protamine sulfate (PS) is given in as high a dose as 2:1. We heparinize our patients with 2.0 mg./kg. of beef lung heparin and reverse this with 70% of the total heparin dose. The mean preoperative activated clotting time (ACT) was 148 seconds. The mean ACT on cardiopulmonary bypass (CPB) was 446 seconds. After successfully weaning the patients from CPB at a bladder temperature of 37°C or greater, the 70% dose of PS was given resulting in a mean ACT of 134 seconds post bypass. The mean post-operative blood loss was 695cc (230cc-3120cc) with only 32% (13 patients) requiring platelet administration and 22% (9 patients) requiring fresh frozen plasma (FFP). No patient required re-operation for hemorrhage. There were 33 coronary artery bypass grafts, all of which were on aspirin and persantine, four aortic valve replacements and three atrial septal defects. These data strongly suggest that heparin reversal can be obtained with low dose PS when these patients are weaned from CPB at 37°C bladder temperature.