Protamine titration to optimize heparin antagonization after cardiopulmonary bypass.

Autor:	Foubert R; Department of Anesthesia, Intensive Care and Emergency Medicine, OLV Hospital Aalst, Aalst, Belgium., Van Vaerenbergh G; Division of Clinical Perfusion, OLV Hospital Aalst, Aalst, Belgium., Cammu G; Department of Anesthesia, Intensive Care and Emergency Medicine, OLV Hospital Aalst, Aalst, Belgium., Buys S; Department of Anesthesia, Intensive Care and Emergency Medicine, OLV Hospital Aalst, Aalst, Belgium., De Mey N; Department of Anesthesia, Intensive Care and Emergency Medicine, OLV Hospital Aalst, Aalst, Belgium., Lecomte P; Department of Anesthesia, Intensive Care and Emergency Medicine, OLV Hospital Aalst, Aalst, Belgium., Bouchez S; Department of Anesthesia, Intensive Care and Emergency Medicine, OLV Hospital Aalst, Aalst, Belgium., Rex S; Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium., Foubert L; Department of Anesthesia, Intensive Care and Emergency Medicine, OLV Hospital Aalst, Aalst, Belgium.
Jazyk:	angličtina
Zdroj:	Perfusion [Perfusion] 2024 Sep; Vol. 39 (6), pp. 1062-1069. Date of Electronic Publication: 2022 Dec 11.
DOI:	10.1177/02676591221144702
Abstrakt:	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. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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