PubMed · 1975 · 374 citations · 11 references
PharmacyHematologyPharmacokineticsDrug ClearanceHemostasisPharmacokinetic ModelingAnticoagulant ManagementAnticoagulation ManagementAnticoagulation TherapyAnticoagulation RegimenHeparin AnticoagulationHeparin-mediated AnticoagulationNeutralizationProtamine AdministrationProtamine ReversalProtamine SulfateSurface Area
The study examined whether existing heparin protocols achieve adequate anticoagulation during extracorporeal circulation and precise protamine neutralization afterward. Five common heparin protocols were evaluated via computer simulation on 50 patients, focusing on those with extreme heparin half‑lives and sensitivities. All five protocols failed to ensure safe anticoagulation or accurate protamine neutralization, whereas a simplified monitoring strategy proved uniformly successful.
Five heparin protocols, representative of about 30 presently used throughout the country, were analyzed. The adequacy of anticoagulation during and the precision of protamine neutralization at the conclusion of extracorporeal circulation were studied. In each of 50 patient's age, height, weight, or surface area was of no help in predicting heparin kinetics. The study group consisted of the 2 patients with the longest and the 2 patients with the shortest heparin half lives, as well as the 2 patients who showed the greatest sensitivity to heparin and the 2 who showed the least. By computer simulation, each was managed according to the five protocols and by a monitoring procedure. The protocols failed to provide safe anticoagulation or precise protamine neutralization, whereas the simplified monitoring approach was uniformly successful.
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