ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Online Discussion
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Massimiliano Codispoti
Pankaj S. Mankad
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Codispoti, M.
Right arrow Articles by Mankad, P. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Codispoti, M.
Right arrow Articles by Mankad, P. S.
Related Collections
Right arrow Cardiac - pharmacology
Right arrow Congenital - cyanotic
Right arrow Extracorporeal circulation
Right arrowRelated Article

Ann Thorac Surg 2001;71:922-927
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

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

Massimiliano Codispoti, MDa, Christopher A. Ludlam, PhDb, David Simpson, FRCAa, Pankaj S. Mankad, PhDa

a Department of Cardiac Surgery, Royal Hospital For Sick Children, Edinburgh, Scotland, United Kingdom
b Department of Hematology, Royal Infirmary, Edinburgh, Scotland, United Kingdom

Accepted for publication September 28, 2000.

Address reprint requests to Dr Mankad, Department of Cardiac Surgery, Royal Infirmary, Lauriston Place, Edinburgh, EH3 9YW, Scotland
e-mail: pankaj.mankad{at}ed.ac.uk

Background. Measurements of activated coagulation time do not correlate with plasma concentration of heparin. This study investigated the effects of a patient-specific method to manage anticoagulation and its reversal in pediatric patients undergoing cardiopulmonary bypass.

Methods. Infants and children were randomly assigned to receive either a standard dose of heparin (300 IU/kg; group C, n = 13) or an individualized dose, 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 heparin for patients in group C and of the residual heparin concentration in group HC.

Results. Administered heparin was significantly higher and total protamine dose was significantly reduced in the HC group (both p <= 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 and fresh frozen plasma were also lower in group HC (all p <= 0.05).

Conclusions. An individualized management of anticoagulation and its reversal results in less activation of the coagulation cascade, less fibrinolysis, and reduced blood loss and need for transfusions. Further studies are warranted to better define the clinical impact of these findings.


Related Article

Invited commentary
Wulf Dietrich
Ann. Thorac. Surg. 2001 71: 927-928. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 Anesth. Analg.Home page
N. A. Guzzetta, T. Bajaj, T. Fazlollah, F. Szlam, E. Wilson, A. Kaiser, S. R. Tosone, and B. E. Miller
A Comparison of Heparin Management Strategies in Infants Undergoing Cardiopulmonary Bypass
Anesth. Analg., February 1, 2008; 106(2): 419 - 425.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T.-Y. Hsia and P. J. Gruber
Factors Influencing Neurologic Outcome After Neonatal Cardiopulmonary Bypass: What We Can and Cannot Control
Ann. Thorac. Surg., June 1, 2006; 81(6): S2381 - S2388.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Huebler, W. Boettcher, A. Koster, M. Emeis, P. Lange, and R. Hetzer
Transfusion-Free Complex Cardiac Surgery With Cardiopulmonary Bypass in a 3.55-Kg Jehovah's Witness Neonate
Ann. Thorac. Surg., October 1, 2005; 80(4): 1504 - 1506.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
P. J. Santrach
Devices for Monitoring Heparin and Protamine in the Operating Room
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2003; 7(4): 379 - 385.
[Abstract] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
W. C. Oliver Jr
Overview of Heparin and Protamine Management and Dosing Regimens in Pediatric Cardiac Surgical Patients
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2003; 7(4): 387 - 410.
[Abstract] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Codispoti and P.S. Mankad
Significant merits of a fibrin sealant in the presence of coagulopathy following paediatric cardiac surgery: randomised controlled trial
Eur. J. Cardiothorac. Surg., August 1, 2002; 22(2): 200 - 205.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2001 by The Society of Thoracic Surgeons.