Risk Factors Associated with Difficult Reversal of Heparin by Protamine Sulfate in Cardiopulmonary Bypass: An Ignored Issue

Abstract

Background: The aim of this study was to evaluate risk factors associated with difficult heparin reversal by protamine after cardiopulmonary bypass. Methods: Data from 120 consecutive patients who underwent open heart surgery from 2009 to 2017 were retrospectively reviewed. Patients were divided into 2 groups: (1) those in whom complete heparin reversal was achieved after a single infusion of protamine (group A, n=89); and (2) those who required more protamine for heparin reversal (group B, n=31). Results: Female sex, prolonged bypass time (>200 min), long aortic cross-clamping time (>120 min), and a lowest rectal temperature <26°C were significant predictors of difficult heparin reversal. Larger amounts of fresh frozen plasma and platelet concentrate were transfused in group B than in group A. Conclusion: Surgeons' efforts to reduce operative time and avoid deep hypothermia may be helpful for increasing the likelihood of easy heparin reversal, especially in female patients.

Heparin reversal with protamine sulfate after Percutaneous Hepatic Perfusion (PHP): is less more?

“…Because the anticoagulant response to heparin varies among patients, the dosage of heparin and its effect must be closely monitored. Activated clotting time (ACT), introduced by Hattersley in 1966, is an objective clotting test used to evaluate the efficacy of heparin in situations that prohibit time consuming laboratory diagnostics [ 14 ]. For PHP, an constant ACT above 400s is mandatory to avoid clotting in the extracorporeal hemofiltration system.…”