Heparin and protamine titration do not improve haemostasis in cardiac surgical patients
| Autor: | Marietta DePerio, Linda Shore-Lesserson, David Reich |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Male
Protamine sulfate medicine.drug_class Blood Loss Surgical Activated clotting time Postoperative Hemorrhage law.invention law Cardiopulmonary bypass Humans Medicine Blood Transfusion Prospective Studies Protamines Cardiac Surgical Procedures Blood coagulation test Analysis of Variance Cardiopulmonary Bypass Chi-Square Distribution Intraoperative Care Dose-Response Relationship Drug medicine.diagnostic_test biology Heparin business.industry Incidence Body Weight Anticoagulant Titrimetry Anticoagulants Heparin Antagonists General Medicine Protamine Hemostasis Surgical Anesthesiology and Pain Medicine Hemostasis Anesthesia biology.protein Drainage Female Blood Coagulation Tests Drug Monitoring business Forecasting medicine.drug |
| Zdroj: | Canadian Journal of Anaesthesia. 45:10-18 |
| ISSN: | 1496-8975 0832-610X |
| Popis: | Weight-based heparin and protamine dosing strategies for cardiopulmonary bypass (CPB) do not take into account interpatient variability in drug sensitivity and may result in bleeding complications. We compared the Hemochron RxDx heparin and protamine titration system with standard weight based management with regard to heparin dose, protamine dose, and perioperative bleeding.One hundred and thirty-five cardiac surgical patients were randomised into four groups. Group 1 received standard heparin and protamine management: Group 2 received heparin and protamine by in vitro titration. Group 3 had the heparin dose titrated, and group 4 had the protamine dose titrated. Coagulation tests, bleeding, and transfusion requirements were measured.The initial heparin bolus predicted by the titration was300 U.kg-1 in all patients. Group 2 received a lower heparin bolus for the initiation of bypass but total heparin doses were not different among groups (group 1 = 365 +/- 43, group 2 = 348 +/- 73 U.kg-1, group 3 = 394 +/- 86 U.kg-1, group 4 = 376 +/- 60; P = 0.06). Groups 2 and 4 received a lower initial and a lower total protamine dose (total dose group 1 = 4.03 +/- 0.65 mg.kg-1, group 2 = 3.56 +/- 1.11 mg.kg-1, group 3 = 4.22 +/- 0.90 mg.kg-1, group 4 = 3.38 +/- 0.98 mg.kg-1, P = 0.001). The incidences of incomplete heparin neutralisation (P = 0.14) and heparin rebound (P = 0.1) were not different among groups. Postoperative bleeding and transfusion requirements did not differ.In cardiac surgical patients, heparin and protamine titration did predict a lower protamine dose but did not result in a measurable improvement in haemostasis during the perioperative period. |
| Databáze: | OpenAIRE |
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