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Plasma Heparin Activity and Antagonism During Cardiopulmonary Bypass with Hypothermia

JERRY A. COHEN, MD^*, EVAN L. FREDERICKSON, MD, and JOEL A. KAPLAN, MD

*Resident and NIH Research Trainee. Professor of Anesthesiology and Pharmacology. Assistant Professor and Director, Division of Cardiothoracic Anesthesia. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30322.

Abstract

Plasma heparin activity in 11 patients undergoing open-heart surgery was measured by comparing thrombin time of patient plasma to thrombin time of plasma containing known heparin concentrations. Although all patients received 300 units/kg of heparin, their initial plasma heparin levels varied significantly, from 1.8 units/ml in lighter patients to 3 units/ml in heavier patients. During hypothermia (25° C), heparin decay was insignificant. At 37° C, heparin decayed at a rate between 0.37 and 2.01 units/ml/hr. This decay was significantly faster in those patients with higher initial post-hypothermia plasma heparin levels.

When heparin was reversed with a protamine dose based on circulating plasma heparin levels, the mean difference between the predicted and the actual residual heparin activity was 0.025 units/ml. Heparin levels vary widely because of the influence of temperature on decay rates and because the space into which heparin is distributed is not simply proportional to weight. Evaluation and reversal of plasma heparin activity require ongoing analysis rather than any 1 dosage protocol.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999