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Anesth Analg 1986; 65:377-380
© 1986 International Anesthesia Research Society
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Rate of Protamine Administration

Its Effect on Heparin Reversal and Antithrombin Recovery after Coronary Artery Surgery

James R. Zaidan, MD, Steve Johnson, MD, Russell Brynes, MD, Sandra Monroe, MT, ASCP, and Anita V. Guffin, MMSC

Received from the Departments of Anesthesiology and Pathology, Emory University School of Medicine, Atlanta, Georgia, CCAA, Inc., Las Vegas, Nevada, and the Department of Anesthesiology, Mount Sinai Medical Center, New York, New York.

Abstract

Patients received a calculated dose of protamine at two different rates (5 min and 30 min) after coronary artery surgery to determinethe relationship of the rate of protamine administration with the adequacy of heparin reversal and the rate of return of antithrombin III (AT III) activity. Plasma heparin concentrations and AT III activities were measured at specific times both during and for 3 days after cardiac surgery. Both rates of protamine administration resulted in clinically acceptable clotting, return of the activated coagulation time to normal, and zero heparin concentration after 24 hr. Two hours after protamine administration, patients who received rapidly administered protamine had prolonged coagulation compared to the other group. Normal AT III activity returned the second postoperative day. These results imply that normal postoperative coagulation occurs when protamine is administered over 30 min without a bolus, and that blood is potentially hypercoagulable immediately after heparin reversal because of depressed AT 111 activity.

Key Words: BLOOD, COAGULATION—heparin, protamine




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1986 by the International Anesthesia Research Society.