In Vivo Protamine Titration Using Activated Coagulation Time to Neutralize Heparin Anticoagulation in Cardiac Surgery:Proof of Concept

ABSTRACT Objective : In vivo protamine titration (IVPT) is based on the observation of a plateau on the decay curve of the celite activated clotting times (ACT) during protamine infusion for heparin reversal. The aim of this study was to determine the optimal protamine: heparin (H/P) ratio to reverse anticoagulation using IVPT curves. Design : Prospective, randomized study. Setting : Tertiary care university hospital. Participants : 138 patients undergoing elective cardiac surgery requiring cardiopulmonary bypass (CPB). Interventions : The control group (CG) was given a protamine infusion of 1.3 mg: 1mg (100U) of heparin over 21 minutes. ACT was measured every 3 minutes. In the test group (TG), protamine dose was prepared using the same ratio as in the CG and ACT values were measured every 3 minutes, until a plateau was reached (two consecutive ACT values Results : The protamine dose was lower in the TG (456.00 ± 105.66 mg (CG) versus 295.25 ± 100.60 mg (TG), p Conclusions : IVPT is safe and efficient in this low-risk population.