ABSTRACT
Introduction and Aim:
To define the changes in activated coagulation time (ACT) and postoperative drainage volume with two different heparin neutralization methods in patients who had coronary bypass surgery.
Material and Methods:
53 patients who had coronary bypass surgery between January 1, 2002 and July 31,2002 at Trakya University Faculty of Medicine Department of Cardiovascular Surgery were taken into the study. Patients were separated into two groups randomly. The patients that were applied protamine, 1.3 folds of total heparin during the operation were as group 1 (n=29) and the patients that heparin neutralization was applied by the calculation of protamine dosage with a graphic at the end of cardiopulmonary bypass (CPB) were as group 2 (n=24). Postoperative ACT and drainage volumes of the groups were compared.
Findings:
Among groups there was no significent difference in terms of age, sex, body mass index, number of grafts, CPB time, cross clamp time, EF and use of LIMA. There was no significent difference in ACT values 5 minutes after protamine application (Group 1= 129.8± 12.6 sec, Group 2= 128.5± 14.1 sec). In group 1, ACT values at 2, 4 and 6 hours after protamine application (131.9± 19.2, 129.129.2± 11.5 and 127.0± 9.2 sec) were prominently higher than in group 2 (118.5± 13.5, 114.4± 9.6 and 111.9± 10.9 sec). Total protamine dosage was found to be significantly higher in group 1 (318.0± 45.2 mg) compared to group 2 (287.7± 42.3 mg). If postoperative 0-2, 2-4, 4-6, 6-12 hours and total drainage volumes were compared; it was found to be significently larger in group 1 (172.4± 91.9, 107.4± 69.4, 92.1± 42.1, 118.8± 81.8 and 876.6± 112.5 ml) than group 2 (91.7± 55.0, 74.2± 63.7, 67.7± 51.9, 71.6± 40.5 and 706.2± 98.3 ml).
Results:
In sufficient neutralization of heparin at the end of CPB may end up with complications such as bleeding, cardiac tamponade and transfusion reactions. In order to reduce these complications, knowing the total amount in patient circulation at the moment and neutralization of that amount with protamine have great importance. Because of this, in calculation of protamine dosage it supplies great advantages to use the graphic obtained by ACT values at basal, after heparinization and at end of CPB.