This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by GUFFIN, A. V. Articles by BLAND, J. W. Search for Related Content PubMed PubMed Citation Articles by GUFFIN, A. V. Articles by BLAND, J. W., JR.

Successful Use of a Reduced Dose of Protamine After Cardiopulmonary Bypass

ANITA V. GUFFIN, MMS^*, RONALD W. DUNBAR, MD, JOEL A. KAPLAN, MD, and JAMES W. BLAND, JR., MD

*Anesthesia Assistant, Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30322. Professor of Anesthesiology, Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30322. Assistant Professor of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30322. Associate Professor of Anesthesiology and Pediatrics, Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30322.

Abstract

The dose of protamine necessary to reverse heparin was examined in 60 patients. Half the patients (controls) received a reversal dose of protamine equal to the entire amount of heparin given them, while half received a reversal dose based on a heparin half-life of 2 hours. Postoperative chest drainage for the first 12 hours and for 48 hours was markedly reduced in patients given the reduced dose of protamine. Platelet counts were higher and postoperative clotting studies varied less from control in patients receiving the smaller dose of protamine. The authors suggest reevaluation of the dose of protamine necessary to reverse the anticoagulant effects of heparin in patients for cardiopulmonary bypass, since larger doses of protamine may contribute to the conditions which increase postoperative bleeding.

This article has been cited by other articles:

				The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]

				N. J. Skubas and G. J. Despotis Optimal Management of Bleeding Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 217 - 228. [Abstract] [PDF]

				T. Miyashita, T. Kamibayashi, Y. Ohnishi, J. Kobayashi, and M. Kuro Preservation of collagen-induced whole blood platelet aggregation by tranexamic acid therapy in primary cardiac valve surgery Perfusion, December 1, 2000; 15(6): 507 - 513. [Abstract] [PDF]

				S. Christiansen, J. Rotker, N. Roeder, U. R. Jahn, J. Stypmann, H. H. Scheld, and C. Schmid Are patients with Werlhof's disease at increased risk for bleeding complications when undergoing cardiac surgery? Eur. J. Cardiothorac. Surg., September 1, 2000; 18(3): 353 - 356. [Abstract] [Full Text] [PDF]

				G. J. Despotis and L. T. Goodnough Management approaches to platelet-related microvascular bleeding in cardiothoracic surgery Ann. Thorac. Surg., August 1, 2000; 70(2): S20 - 32. [Abstract] [Full Text] [PDF]

				G. J. Despotis, J. H. Joist, and L. T. Goodnough Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes Clin. Chem., September 1, 1997; 43(9): 1684 - 1696. [Abstract] [Full Text] [PDF]

				D. R. Jobes, G. L. Aitken, and G. W. Shaffer Increased accuracy and precision of heparin and protamine dosing reduces blood loss and transfusion patients undergoing primary cardiac operations J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 36 - 45. [Abstract] [Full Text]

				G. J. Despotis, J. H. Joist, C. W. Hogue Jr., A. Alsoufiev, K. Kater, L. T. Goodnough, S. A. Santoro, E. Spitznagel, M. Rosenblum, and D. G. Lappas The impact of heparin concentration and activated clotting time monitoring on blood conservation: A prospective, randomized evaluation in patients undergoing cardiac operation J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 46 - 54. [Abstract] [Full Text]

				G. J. Despotis, A. L. Summerfield, J. H. Joist, L. T. Goodnough, S. A. Santoro, E. Spitznagel, J. L. Cox, and D. G. Lappas Comparison of activated coagulation time and whole blood heparin measurements with laboratory plasma anti-Xa heparin concentration in patients having cardiac operations J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1076 - 1082. [Abstract] [Full Text]

				G. A. DeLaria, J. J. Tyner, C. L. Hayes, and B. W. Armstrong Heparin-Protamine Mismatch: A Controllable Factor in Bleeding After Open Heart Surgery Arch Surg, September 1, 1994; 129(9): 945 - 951. [Abstract] [PDF]