HEPARIN ADMINISTRATION DURING EXTRACORPOREAL-CIRCULATION - HEPARIN REBOUND AND POST-OPERATIVE BLEEDING

  • 1 January 1979
    • journal article
    • research article
    • Vol. 78  (1) , 95-102
Abstract
Individual variations in heparin dose response and heparin activity decay indicated limitations of protocols based on body surface area and weight of the patient. Heparin levels and clotting tests were monitored in 71 patients undergoing cardiac operations. Clotting tests were the Celite activated clotting time (Celite ACT) and the whole blood activated recalcification time (BART). Forty-four patients received a loading dose of heparin (3 mg/kg), a maintenance dose of heparin (1.5 mg/kg per h) and 6 mg/kg protamine sulfate after extracorporeal circulation (ECC) (Protocol I). Twenty-seven patients received a similar initial dose, but the maintenance dose of heparin and the dosage of protamine sulfate were administered according to the measured heparin levels (Protocol II). A significant difference was seen in the measured heparin levels (P < 0.01), Celite ACT (P < 0.01) and BART (P < 0.01) in patients on Protocols I and II. Of the 24 patients, 10 on Protocol I and none on Protocol II showed heparin rebound phenomenon, and blood loss in patients on Protocol I was significantly greater than in patients on Protocol II. This protocol of heparin administration and control with simple tests ensures safe hypocoagulation during ECC and efficient reversal at the end, with minimal postoperative blood loss.

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