Review Article

Are We Able to Dose Protamine Accurately Yet? A Review of the Protamine Conundrum

^* Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, Canada
^† Department of Haematology; and
^‡ Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom

Address correspondence to: Florian Falter, MD, FRCA, FFICM, PhD, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom CB2 0AY. E-mail: florian.falter@gmail.com

Received: 20 November 2019
Accepted: 11 February 2020

Abstract

Without anticoagulation, cardiopulmonary bypass would not have developed over the last nearly 60 years into one of the most influential innovations in medicine; without the ability to reverse anticoagulation, cardiac surgery might not have become the common intervention, which is now practiced globally. Despite the recent breathtaking developments in extracorporeal technology, heparin and protamine remain the pillars of anticoagulation and its reversal until this day. However, there is still much controversy in particular about protamine dosing regimens. A number of recent publications investigating various approaches to dosing protamine have rekindled this debate. This review is seeking to capture the current thinking about protamine dosing after cessation of cardiopulmonary bypass.