THE STUDY OF INJECTED HEPARIN EXISTENCE DURING VASCULAR SURGERY IN THE PATIENTS BLOOD BEFORE ITS NUTRALIZATION BY PROTAMINE

Heparine is a anticoagulation substance used in vascular surgery to prevent thrombosis during opration and after a while becomes neutralized by protamin an antiheparin drug. Protamine causes some dangerous complications including cardiovascular collapse, anaphilactoid reation, hypotention, bradycardia and bronchospasm. Using higher doses, also protamine leads to increase anticoagolation effect and results in bleeding. In this prospective study 50 patients candidate of vascular surgery such as ventricular aortic aneurism, aorticbypass, endarterctomy carotid, trauma vascular graft were evaluated using a simple and exact test called activated clotting time (ACT), their coagulation condition before giving heparin as basis (ACT1), and before using protamine (ACT2) were mausured. Heparin dose injected to all patients were 5000 units in this study. difference between ACT1 and ACT2 levels were statistically significant. But a considerable percentage of patients (44%) had acceptable level of ACT2 although not yet had returned to the base level. In study of relation between the variables, it was observed that ACT2 had significant relationship with duration of injection between protamine and heparin. When the time is longer, ACT2 will be nearer to ACT1. ACT2 did not have any significant relation with age and weight. We sugest that ACT was measured in all patient before protamin injection if ACT2 was in a acceptable range, the patient would be observed and the bleeding when ocured, protamine should be injected. In this way we donot need injection or inject with lower doses based on the dose of injected heparin in order to prevent dangerous complications of this drug.