Abstract
Determining the proper dosage of protamine for heparin reversal in open-heart surgery is often arbitrary and both under-and overdosing are possible. We describe here a method of protamine administration that was studied in 50 patients undergoing open heart surgery. Protamine was given as a slow, controlled infusion guided by repeated activated clotting time measurements till the earliest return of these values to base-line levels. Using this technique, 39 (78%) patients had an adequate heparin reversal at the end of surgery, at doses of protamine less than those used conventionally. There was no unusual increase in 24-hour chest tube drainage in these patients. The method appears to be a safe and effective alternative to traditional protocols of heparin neutralisation.
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