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In Vivo Protamine Titration Using Activated Coagulation Time to Neutralize Heparin Anticoagulation in Cardiac Surgery: Proof of Concept.

Authors
  • Rochon, Antoine G1
  • Bélisle, Sylvain2
  • Couture, Pierre2
  • Fortier, Annik3
  • Lebon, Jean-Sébastien2
  • Deschamps, Alain4
  • 1 Department of Anesthesia, Montreal Heart Institute, Montreal, Quebec, Canada. Electronic address: [email protected] , (Canada)
  • 2 Department of Anesthesia, Montreal Heart Institute, Montreal, Quebec, Canada. , (Canada)
  • 3 Department of Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. , (Canada)
  • 4 Department of Anesthesia, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. , (Canada)
Type
Published Article
Journal
Journal of cardiothoracic and vascular anesthesia
Publication Date
Sep 01, 2020
Volume
34
Issue
9
Pages
2369–2374
Identifiers
DOI: 10.1053/j.jvca.2019.12.046
PMID: 32014311
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In vivo protamine titration (IVPT) is based on the observation of a plateau on the decay curve of the celite activated clotting times (ACTs) during protamine infusion for heparin reversal. The aim of the present study was to determine the optimal protamine/heparin ratio to reverse anticoagulation using IVPT curves. Prospective, randomized study. Tertiary care university hospital. The study comprised 138 patients undergoing elective cardiac surgery requiring cardiopulmonary bypass. The control group was given a protamine infusion of 1.3 mg per 1 mg (100 U) of heparin over 21 minutes. ACT was measured every 3 minutes. In the test group, the protamine dose was prepared using the same ratio as for the control group, and ACT values were measured every 3 minutes until a plateau was reached (2 consecutive ACT values <160 s), at which time the protamine infusion was stopped. The protamine/heparin ratio, blood losses, transfusions, and heparin concentrations were recorded. The protamine dose was lower in the test group (456.00 ± 105.66 mg [control group] v 295.25 ± 100.60 mg [test group]; p < 0.0001). The mean protamine/heparin ratios were 1.30 ± 0.10 (control group) and 0.81 ± 0.22 (test group) (p < 0.0001). Heparin concentrations were greater in the test group 15 minutes (0.10 [0-0.2] U/mL v 0 [0-0.1] U/mL; p = < 0.0001) and 3 hours (0 [0-0.1] U/mL v 0 [0-0] U/mL; p = 0.0002) after protamine infusion. There was no difference in the blood losses and transfusion requirements. IVPT is safe and efficient in this low-risk population. Copyright © 2020 Elsevier Inc. All rights reserved.

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