Acik kalp cerrahisinde antikoagulasyonun monitorizasyonu; heparin- protamin titrasyonu ve aktive koagulasyon zamani

Two different methods in monitoring anticoagulant effect of heparin; Heparin-Protamin Titration (HPT) and ACT have been compared in two patients groups during intraoperative and postoperative period in terms of ACT, hemoglobin, total doses of heparin and protamin, transfusion requirements and postoperative bleeding. Group I (n=18) was ACT and Group II (n=17) was HPT groups. Standard protocol was used for anaesthesia and ACT, Hb, rectal temperature, heparin concentration (Group II) were recorded at the following intervals; before heparin (Baseline) and after heparin administration at CPB, during CPB at 30th and 60th min, after rewarming and after protamine administration. ACT, Hb and drain volume (mL) were recorded at postoperative first, 3th and 6th hrs. ACT was higher in Group II at CPB, 30 min and after rewarming during CPB (p<0.05). Total heparin doses were similar between groups whereas total protamin dose obtained through hepcon was higher in Group II (p<0.05). Mean amount of drain volume was higher in Group II than Group I. Groups were similar in terms of intraoperative and postoperative Hb values and transfusion requirements. We conclude that both methods are appropriate for monitoring anticoagulation, HPT is advantageous in its expression of patient specific data on the amount of optimum heparin and protamin dose. These two methods can be evaluated in patients that are resistant to heparin or that show rebound and a cost analysis can be performed before routine use.