• Oskar Hällgren, Staffan Svenmarker, and Micael Appelblad.
• Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden.
• J. Cardiothorac. Vasc. Anesth. 2017 Apr 1; 31 (2): 516-521.

ObjectivesTo implement a statistical model for protamine titration.DesignProspective randomized trial.SettingUniversity hospital.ParticipantsSixty (n = 30+30) patients scheduled for elective coronary artery bypass surgery were randomly assigned to 2 groups.InterventionsProtamine dose calculated according to an algorithm established from a statistical model or to a fixed protamine-heparin dose ratio (1:1).Measurements And Main ResultsBoth groups demonstrated comparable patient demographics and intraoperative data. Coagulation effects were evaluated using rotational thromboelastometry. Using the statistical model reduced (p<0.01) the protamine dose from 426±43 mg to 251±66 mg, followed by significantly (p<0.01) shorter intrinsic clotting time (208±29 seconds versus 244±52 seconds) and stronger clot firmness (p = 0.01), and effects on indices of extrinsic or fibrinogen coagulation pathways were insignificant. Test of residual heparin was negative in all patients after protamine administration, aligned with insignificant (p = 0.27) intergroup heparinase-verified clotting time differences.ConclusionsThe statistical model for protamine titration is clinically feasible and protects the patient from exposure to excessive doses of protamine, with advantageous effects on coagulation as measured using rotational thromboelastometry. Significance regarding clinical outcome is yet to be defined.Copyright © 2017 Elsevier Inc. All rights reserved.

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