PMID- 36471142
OWN - NLM
STAT- MEDLINE
DCOM- 20230228
LR  - 20231226
IS  - 1496-8975 (Electronic)
IS  - 0832-610X (Linking)
VI  - 70
IP  - 2
DP  - 2023 Feb
TI  - Minimum protamine dose required to neutralize heparin in cardiac surgery: a 
      single-centre, prospective, observational cohort study.
PG  - 219-227
LID - 10.1007/s12630-022-02364-4 [doi]
AB  - PURPOSE: Excess protamine contributes to coagulopathy following cardiopulmonary 
      bypass (CPB) and may increase blood loss and transfusion requirements. The 
      primary aim of this study was to find the least amount of protamine necessary to 
      neutralize residual heparin following CPB using the gold standard assays of 
      anti-IIa and anti-Xa activity. Secondary objectives were to evaluate whether the 
      post-CPB activated clotting time could be used as a surrogate marker for 
      quantifying heparin neutralization. METHODS: Twenty-eight consecutive patients 
      undergoing elective cardiac surgery were enrolled. Protamine administration was 
      standardized through an infusion pump at 25 mg.min(-1). Blood samples were 
      withdrawn prior to and following administration of 150, 200, 250, and 300 mg 
      protamine and analyzed for activated clotting time and anti-IIa and -Xa activity. 
      RESULTS: Following a mean (standard deviation) cumulative heparin dose of 67,700 
      (19,400) units and a CPB duration of 113 (71) min, protamine requirements varied 
      widely. Eight out of 25 (32%) patients showed complete neutralization of anti-IIa 
      and -Xa activity at the first sampling point (150 mg protamine; protamine:heparin 
      ratio, 0.3 [0.1]). A protamine:heparin ratio of 0.5 (0.2) was sufficient for 
      heparin neutralization in > 90% of patients. After CPB, a low to mid-range 
      activated clotting time correlated well with anti-IIa and -Xa activity. 
      CONCLUSIONS: The protamine:heparin ratio required to neutralize residual 
      unfractionated heparin (UFH) following CPB is variable. A protamine:heparin ratio 
      of 0.3 was sufficient to neutralize UFH in some patients, while a ratio of 0.5 is 
      sufficient to neutralize both residual anti-IIa and -Xa activity in most 
      patients. Larger studies are necessary to confirm these findings and evaluate 
      their clinical implications. STUDY REGISTRATION: ClinicalTrials.gov 
      (NCT03787641); registered 26 December 2018.
CI  - (c) 2022. Canadian Anesthesiologists' Society.
FAU - Taneja, Ravi
AU  - Taneja R
AUID- ORCID: 0000-0002-5361-9208
AD  - Department of Anesthesia and Perioperative Medicine, London Health Sciences 
      Centre, London, ON, Canada. ravi.taneja@lhsc.on.ca.
AD  - Division of Critical Care, Department of Medicine, London Health Sciences Centre, 
      University Hospital, B2-223, 339 Windermere Road, London, ON, N6A 5A5, Canada. 
      ravi.taneja@lhsc.on.ca.
FAU - Szoke, Daniel J
AU  - Szoke DJ
AD  - Department of Anesthesia and Perioperative Medicine, London Health Sciences 
      Centre, London, ON, Canada.
FAU - Hynes, Zachary
AU  - Hynes Z
AD  - Department of Anesthesia and Perioperative Medicine, London Health Sciences 
      Centre, London, ON, Canada.
FAU - Jones, Philip M
AU  - Jones PM
AD  - Department of Anesthesia and Perioperative Medicine, London Health Sciences 
      Centre, London, ON, Canada.
AD  - Department of Epidemiology & Biostatistics, University of Western Ontario, 
      London, ON, Canada.
LA  - eng
SI  - ClinicalTrials.gov/NCT03787641
GR  - R3913A05/Anesthesia Internal Research Fund (Western University)/
PT  - Journal Article
PT  - Observational Study
TT  - Dose minimale de protamine requise pour neutraliser l'heparine en chirurgie 
      cardiaque : une etude de cohorte observationnelle prospective monocentrique.
DEP - 20221205
PL  - United States
TA  - Can J Anaesth
JT  - Canadian journal of anaesthesia = Journal canadien d'anesthesie
JID - 8701709
RN  - 9005-49-6 (Heparin)
RN  - 0 (Protamines)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Humans
MH  - *Heparin
MH  - Protamines
MH  - Prospective Studies
MH  - *Cardiac Surgical Procedures
MH  - Cohort Studies
MH  - Cardiopulmonary Bypass
MH  - Anticoagulants
OTO - NOTNLM
OT  - activated clotting time
OT  - cardiac surgery
OT  - cardiopulmonary bypass
OT  - heparin
OT  - protamine
EDAT- 2022/12/06 06:00
MHDA- 2023/03/03 06:00
CRDT- 2022/12/05 23:39
PHST- 2022/03/28 00:00 [received]
PHST- 2022/08/12 00:00 [accepted]
PHST- 2022/08/10 00:00 [revised]
PHST- 2022/12/06 06:00 [pubmed]
PHST- 2023/03/03 06:00 [medline]
PHST- 2022/12/05 23:39 [entrez]
AID - 10.1007/s12630-022-02364-4 [pii]
AID - 10.1007/s12630-022-02364-4 [doi]
PST - ppublish
SO  - Can J Anaesth. 2023 Feb;70(2):219-227. doi: 10.1007/s12630-022-02364-4. Epub 2022 
      Dec 5.