J Extra Corpor Technol
Volume 45, Number 4, December 2013
|Page(s)||235 - 241|
|Published online||15 December 2013|
Method to Calculate the Protamine Dose Necessary for Reversal of Heparin as a Function of Activated Clotting Time in Patients Undergoing Cardiac Surgery
* Meixoeiro Hospital, University of Vigo Hospital Complex, Galaria, Vigo, Spain
† Clinical Hospital, University of Santiago de Compostela Hospital Complex, Santiago de Compostela, Spain
‡ University of Vigo Hospital Complex, Vigo, Spain
Address correspondence to: Javier Suárez Cuenca, Hospital Meixoeiro, Secretaría Cirugía Cardiaca, Galaria, Meixoeiro s/n, 36200 Vigo, (Pontevedra), Spain. E-mail: firstname.lastname@example.org
Accepted: 16 November 2013
Activated clotting time (ACT) has been used to monitor coagulation and guide management of anticoagulation control in patients undergoing cardiac surgery for decades. However, reversal of heparin with protamine is typically empirically based on total heparin administered. Dose-related adverse effects of protamine are well described. The aim of this study was to evaluate a heparin reversal strategy based on calculation of the protamine dose based on ACT measurements. We present a method using a mathematical formula based on the dose–response line (1). To check the formula, we performed a retrospective observational cohort study of 177 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The study group of 80 patients was administered the dose of protamine obtained using our formula, and the control group of 97 patients was administered the empirically calculated dose. The ACT returned to normal values in patients who were given doses of protamine that were calculated using our formula; all but two had a final ACT of 141. The application of the formula resulted in a significant reduction in the dose of protamine (p < .023). The formula we present is a valid method for calculating the dose of protamine necessary to neutralize heparin. This same method can be used working with a target ACT to adjust the dose of heparin. As a result of its functionality, it allows application on a daily basis standardizing the process. We believe that the formula we developed can be applied in all those procedures in which it is necessary to anticoagulate patients with heparin and later neutralization (cardiac surgery with or without CPB, vascular surgery, procedures of interventional cardiology, and extracorporeal depuration procedures).
Key words: cardiopulmonary bypass / heparin / protamine / ACT
© 2013 AMSECT
Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.
Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.
Initial download of the metrics may take a while.