Differentiation of Bleeding Diatheses Which Occur Following Protamine Correction of Heparin Anticoagulation

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Abstract
Among patients who develop a bleeding diathesis following protamine neutralization of heparin anticoagulation, the differential diagnosis includes hyperheparinemia, disseminated intravascular coagulation, and protamine excess. The use of the activated partial thromboplastin time in conjunction with the thrombin time and protamine corrected thrombin time is helpful in differentiating among these conditions. Illustrative cases are presented.