Appropriate Protamine Administration to Neutralize Heparin after Cardiopulmonary Bypass Using the Hepcon/HMS / 日本心臓血管外科学会雑誌

ABSTRACT

We reevaluated our heparin and protamine administration protocol during and after cardiopulmonary bypass (CPB). In 12 patients who underwent cardiac surgery using a heparin-coated circuit under mild hypothermia, heparin concentration was measured with the Hepcon^®/HMS. Before initiating CPB, 1.5mg/kg of heparin was given to maintain the activated clotting time (ACT) at more than 400sec. Patients were divided into two groups. In group I (<i>n</i>=6), heparin was neutralized with an empirical dose of protamine (1.5mg protamine/mg initial heparin). In group II (<i>n</i>=6), the protamine dose was determined by the residual heparin concentration, measured with the Hepcon^®. Patients in group II received a lower dosage of protamine than group I (1.7±0.0 vs. 3.6±0.4mg/kg, <i>p</i><0.001). There were no significant differences in the intraoperative bleeding, postoperative bleeding and activated clotting time between the groups. By determining the appropriate protamine dosage, this heparin analysis system may be useful in managing CPB.