Sodium Heparin Neutralization and the Anticoagulant Effects of Protamine Sulfate

Jerry R. Adkins, MD; James D. Hardy, MD
Arch Surg. 1967;94(2):175-177. doi:10.1001/archsurg.1967.01330080013004.
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THE IN VIVO relationship between sodium heparin administered for anticoagulation and protamine sulfate given to neutralize its effects are of substantial clinical importance. Such therapy is used routinely in open heart surgery and commonly in a wide variety of other operations. Certain patients appear to be more sensitive to a given amount of sodium heparin administered on a weight basis than are others; and it often appears that more protamine sulfate is required to neutralize a given dose of heparin in one patient than in another, the body weights and time intervals being similar. Furthermore, it has long been appreciated that very large doses of protamine sulfate actually produce an anticoagulant effect in mammals. Thus the purpose of the investigation herein presented was to examine the stoichiometric relationship between graded doses of sodium heparin and protamine sulfate in small dogs of similar weight and to measure the effect of large


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