Protamine — What dose?

Heparin anticoagulation following cardiopulmonary bypass (CPB) is conventionally reversed with an empirical dose of protamine based on the patient's body weight and the dose of heparin administered. This may result in under or over dosing and does not guarantee optimal reversal of anticoagulation. Protamine has adverse haemodynamic effects and may act as an anticoagulant itself. Estimation of the dose of protamine by titration may allow better prediction of the protamine requirement. This study was designed to compare the protamine dose estimated from a protamine titration slope with an empirical dose regime.