Evidence map›Paper›PMID 36471142›Full record

Observational studyCanadian journal of anaesthesia = Journal canadien d'anesthesie2023

Minimum protamine dose required to neutralize heparin in cardiac surgery: a single-centre, prospective, observational cohort study.

Ravi Taneja, Daniel J Szoke, Zachary Hynes, Philip M Jones

Registry-linked trialOpen access · bronzeAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03787641 (Sysytematic Evaluation of Heparin and Protamine in Cardiac Surgery), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
2.8field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03787641 naunknown statusnot on this map

Sysytematic Evaluation of Heparin and Protamine in Cardiac Surgery

TypeinterventionalSponsorLondon Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph'sRan2018 to 2020Enrolled100ConditionsCardiac Surgery With Cardiopulmonary BypassArmsProtamine Sulfate
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 15 citations in OpenAlex.

  1. The protamine-to-heparin ratio: concept and clinical application.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026
    Article
  2. Article
  3. Article
  4. Protamine and Heparin Interactions: A Narrative Review.Annals of cardiac anaesthesia · 2024
    Review
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Ravi TanejaDepartment of Anesthesia and Perioperative Medicine, London Health Sciences Centre, London, ON, Canada. ravi.taneja@lhsc.on.ca.ORCID http://orcid.org/0000-0002-5361-9208
Daniel J SzokeDepartment of Anesthesia and Perioperative Medicine, London Health Sciences Centre, London, ON, Canada.
Zachary HynesDepartment of Anesthesia and Perioperative Medicine, London Health Sciences Centre, London, ON, Canada.
Philip M JonesDepartment of Anesthesia and Perioperative Medicine, London Health Sciences Centre, London, ON, Canada.
London Health Sciences Centre · CAWestern University · CA

Funding

Anesthesia Internal Research Fund (Western University) R3913A05
6 · The paper itself

Abstract

purposeExcess protamine contributes to coagulopathy following cardiopulmonary bypass (CPB) and may increase blood loss and transfusion requirements. The primary aim of this study was to find the least amount of protamine necessary to neutralize residual heparin following CPB using the gold standard assays of anti-IIa and anti-Xa activity. Secondary objectives were to evaluate whether the post-CPB activated clotting time could be used as a surrogate marker for quantifying heparin neutralization.

methodsTwenty-eight consecutive patients undergoing elective cardiac surgery were enrolled. Protamine administration was standardized through an infusion pump at 25 mg·min

resultsFollowing a mean (standard deviation) cumulative heparin dose of 67,700 (19,400) units and a CPB duration of 113 (71) min, protamine requirements varied widely. Eight out of 25 (32%) patients showed complete neutralization of anti-IIa and -Xa activity at the first sampling point (150 mg protamine; protamine:heparin ratio, 0.3 [0.1]). A protamine:heparin ratio of 0.5 (0.2) was sufficient for heparin neutralization in > 90% of patients. After CPB, a low to mid-range activated clotting time correlated well with anti-IIa and -Xa activity.

conclusionsThe protamine:heparin ratio required to neutralize residual unfractionated heparin (UFH) following CPB is variable. A protamine:heparin ratio of 0.3 was sufficient to neutralize UFH in some patients, while a ratio of 0.5 is sufficient to neutralize both residual anti-IIa and -Xa activity in most patients. Larger studies are necessary to confirm these findings and evaluate their clinical implications. STUDY REGISTRATION: ClinicalTrials.gov (NCT03787641); registered 26 December 2018.

Indexed as

Cardiac Surgical ProceduresHeparinAnticoagulantsCardiopulmonary BypassCohort StudiesHumansProspective StudiesProtaminesAnticoagulantsHeparinProtaminesactivated clotting timecardiac surgerycardiopulmonary bypassheparinprotamine

Identifiers

PMID36471142
OpenAlexW4310772664

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.