Dr. Bulatovic (PGY4) and Dr. Taneja respond to a retrospective cardiac surgery study in Anesthesiology

Anesthesiology. 2015 Oct;123(4):974-5

Heparin for cardiac surgery: Old and forgotten? 

Bulatovic R, Taneja R.

In reference to: Karkouti K, McCluskey SA, Callum J, Freedman J, Selby R, Timoumi T, Roy D, Rao V. Evaluation of a novel transfusion algorithm employing point-of-care coagulation assays in cardiac surgery: a retrospective cohort study with interrupted time-series analysis. Anesthesiology. 2015 Mar;122(3):560-70.


"We read with interest the article by Karkouti et al. published in the March 2015 issue regarding a transfusion algorithm based on point-of-care coagulation tests in cardiac surgery.

We wish to shed light on an issue that was not touched upon in the article but represents the first step in their algorithm and, without dispute, the first and most important single intervention in managing respond to postcardiopulmonary bypass coagulopathy.

The dose of the heparin neutralization by protamine is shown in the algorithm as a ratio of milligrams to milligram. It has long been recommended that heparin should not be quantified in milligram, but in units. In fact, to our knowledge, none of the currently available commercial heparins display its potency in milligram. This quantification of heparin in milligram introduces risk if the ordering physician is unfamiliar with the milligram to unit conversion..."

See the correspondence in PubMed

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