Individualized heparin and protamine management in infants and children undergoing cardiac operations

Background. Measurements of activated coagulation time do not correlate wit h plasma concentration of heparin. This study investigated the effects of a patient-specific method to manage anticoagulation and its reversal in pedi atric patients undergoing cardiopulmonary bypass. Methods. Infants and children were randomly assigned to receive either a st andard dose of heparin (300 IU/kg; group C, n = 13) or an individualized do se, calculated by an in vitro heparin dose-response test (group HC, n = 13) . Protamine dose was based on a 1 mg/1 mg ratio of total administered hepar in for patients in group C and of the residual heparin concentration in gro up HC. Results. Administered heparin was significantly higher and total protamine dose was significantly reduced in the HC group (both p less than or equal t o 0.001). There was less thrombin generation (p = 0.02) and fibrinolysis (p = 0.05) in group HC. Blood loss and requirement for transfusion of blood a nd fresh frozen plasma were also lower in group HC (all p less than or equa l to 0.05). Conclusions. An individualized management of anticoagulation and its revers al results in less activation of the coagulation cascade, less fibrinolysis , and reduced blood loss and need for transfusions. Further studies are war ranted to better define the clinical impact of these findings. (C) 2001 by The Society of Thoracic Surgeons.