Can extra protamine eliminate heparin rebound following cardiopulmonary bypass surgery?
Autor: | Jack Hirsh, M. Blackall, Edward Young, Robin S. Roberts, Kevin Teoh |
---|---|
Rok vydání: | 2004 |
Předmět: |
Male
Time Factors medicine.medical_treatment Blood Loss Surgical 030204 cardiovascular system & hematology law.invention 0302 clinical medicine 030202 anesthesiology law Protamines Saline General Nursing Cardiopulmonary Bypass biology Antithrombin Anticoagulant Heparin Antagonists Blood Proteins Heparin Middle Aged Blood proteins Cardiac surgery 3. Good health Anesthesia Female Cardiology and Cardiovascular Medicine Protein Binding medicine.drug Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.drug_class Context (language use) Placebo 03 medical and health sciences Double-Blind Method medicine Cardiopulmonary bypass Humans Blood Transfusion Postoperative Care business.industry Anticoagulants Protamine 030228 respiratory system biology.protein Surgery business |
Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 128:211-219 |
ISSN: | 0022-5223 |
Popis: | ObjectivesHeparin rebound, the reappearance of anticoagulant activity after adequate neutralization with protamine, is thought to contribute to excessive postoperative bleeding after cardiac surgery. We have previously demonstrated that a significant amount of heparin is bound nonspecifically to plasma proteins and is incompletely neutralized by protamine. The aim of this study was to investigate whether clinically important bleeding attributable to heparin rebound can be eliminated by infusion of small amounts of additional protamine for 6 hours postoperatively and whether this treatment can reduce mediastinal blood loss.MethodsThree hundred patients undergoing elective cardiac surgery were randomized to receive either a continuous infusion of protamine sulphate (25 mg/h for 6 hours) postoperatively or saline placebo. Serial blood samples were obtained to measure thrombin clotting time and anti-factor Xa activity. Heparin bound nonspecifically to plasma proteins was measured after displacement with a chemically altered heparin with low affinity to antithrombin. Mediastinal blood loss and transfusion requirements were recorded.ResultsHeparin rebound was demonstrated in every patient in the placebo group as reflected by increased thrombin clotting time, anti-factor Xa activity, and protein-bound heparin between 1 and 6 hours after surgery. In contrast, heparin rebound was eliminated in the protamine infusion group. The thrombin clotting time was normalized and both heparin concentration and protein-bound heparin were almost undetectable (P < .001). There was a modest 13% reduction in postoperative bleeding but this did not reduce blood transfusions. No adverse events were attributable to the extra protamine.ConclusionsPostoperative protamine infusion was able to almost totally abolish heparin rebound. In the context of this study, protamine infusion resulted in reduced postoperative bleeding but the magnitude was insufficient to alter transfusion requirements. |
Databáze: | OpenAIRE |
Externí odkaz: |