COMPARISON OF EMPIRICAL PROOTAINE DOSE STRATEGY WITH CALCULATED DOSE BASED ON HEPARIN DOSE RESPONSE CURVE POST CARDIOPULMONARY BYPASS IN CABG PATIENTS

Objective: To investigate whether calculated Protamine dose can obtain satisfactory post Heparin reversal ACT results and reduce protamine usage compared with traditional empirical full protamine dosage. Study Design: Randomized controlled trial. Place and Duration of Study: Armed Forces Institute of Cardiology/NIHD between Nov 2018 and Feb 2019. Methodology: Peri-operative ACT results of 240 consecutive patients, undergoing on pump coronary artery bypass graft (CABG) surgery were collected, they were randomly divided into two groups A and B, Heparin was reversed by administering a calculated protamine dose based on Heparin dose response curve in group A and full dose Protamine (1mg per 100 IU) in group B. Baseline ACT, total Heparin dose administered, Protamine dose, post Protamine ACT were recorded for all patients. Results: Post Heparin reversal ACT is returned to near baseline values 107.80 ± 14.471 compared with control ACT 106.90 ± 16.843 (p-value 0.006) in group A patients, and satisfactory ACT 124.10 ± 20.415 levels in patients of group B, but accompanied with significant additional doses of protamine (p-valve 0.02). Conclusion: Both doses of Protamine whether empirical full dose or based on Heparin Dose response curve provides optimal heparin reversal, while full dose protamine is associated with unnecessary protamine additional doses.