Protamine titration to optimize heparin antagonization after cardiopulmonary bypass

• Published in: Perfusion 2024-09, Vol.39 (6), p.1062-1069
• Main Authors: Foubert, Ruben, Van Vaerenbergh, Geert, Cammu, Guy, Buys, Sara, De Mey, Nathalie, Lecomte, Patrick, Bouchez, Stefaan, Rex, Steffen, Foubert, Luc
• Format: Article
• Language: English
• Subjects: Aged; Cardiopulmonary Bypass - methods; Clotting; Coronary artery; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary vessels; Design optimization; Female; Grafting; Heart surgery; Heparin; Heparin - administration & dosage; Heparin - therapeutic use; Heparin Antagonists - administration & dosage; Heparin Antagonists - therapeutic use; Humans; Male; Middle Aged; Overdose; Patients; Prospective Studies; Protamine sulfate; Protamines - administration & dosage; Protamines - therapeutic use; Surgery; Titration; Weaning
• ISSN: 0267-6591; 1477-111X; 1477-111X
• DOI: 10.1177/02676591221144702

Objectives To optimize protamine titration for heparin antagonization after weaning from cardiopulmonary bypass (CPB). Design A prospective, observational trial. Setting Single-center, non-university teaching hospital. Participants Forty patients presenting for elective on-pump coronary artery bypass grafting with or without single valve surgery. Interventions At the end of CPB, the residual amount of heparin in the patient was estimated using a Bull-curve. The total protamine dose was calculated as 1 unit of protamine for 1 unit of heparin. Protamine was administered as 5 aliquots containing 20% of the total protamine dose each, with 2-min intervals. Measurements and main results Activated Clotting Time (ACT) values were measured 2 min after administration of each aliquot. ROTEM(®)-analysis was performed after the full dose of protamine had been administered. After 60% of the total protamine dose had been administered, ACT values were normalized in 86.5% of patients. After the complete dose of protamine had been administered, 61.1% of patients displayed signs of protamine overdose on ROTEM(®)-analysis. Conclusions In patients who present for on-pump coronary artery bypass grafting with or without single valve surgery, a 0.6-to-1 ratio of protamine-to-heparin to antagonize heparin may be sufficient and beneficial for patients.