title: Neutralization of heparin after extracorporeal circulation.
abstract: In a two group-study of patients with and without postoperative haemorrhagic diathesis after ECC tests were undertaken to ascertain whether a postoperative haemorrhagic diathesis after neutralization of Heparin is due to the use of protamine-chloride or stet to a preoperative existing disturbance of the coagulation system. At the end of the ECC, a strongly marked fibrinolysis has been found to take place, together with an increased turnover of coagulation factors i.e. DIC. These results indicate that we are not concerned with a primary fibrinolysis, which would be characterized by plasminaemia, but rather with a reactive fibrinolysis. This coagulation disturbance was more marked in the group with postoperative haemorrhagic diathesis and it became even more pronounced after neutralization with protamine-chloride. From the results we obtained in our tests, the bleeding which occurs after the neutralization of heparin with protamine-chloride can be explained by increased DIC. We think a so-called "heparin-rebound-effect" is improbable as a cause of this postoperative bleeding complication. When there is DIC at the end of the by-pass time, one should avoid neutralizing the heparin and continue the heparin treatment for the same reason.
mesh_terms: D004211:Disseminated Intravascular Coagulation / Q000150:complications*; D004336:Drug Antagonism; D005112:Extracorporeal Circulation; D005342:Fibrinolysis; D006330:Heart Defects, Congenital / Q000601:surgery; D006474:Hemorrhagic Disorders / Q000209:etiology*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D011183:Postoperative Complications; D011479:Protamines / Q000627:therapeutic use
chemical_list: D011479:Protamines; D006493:Heparin