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Impact of different dosage of protamine on heparin reversal during off-pump coronary artery bypass: a clinical study.

Suelzu S, Cossu A, Pala G, Portoghese M, Columbanu V, Sales G, Solinas L, Brazzi L - Heart Lung Vessel (2015)

Bottom Line: We found that the administration of 2/3 of Total Calculated Dose of protamine was always able to reverse the anticoagulant effect of heparin and that a significant clotting time elongation was induced by the infusion of the second part of the Total Calculated Dose of protamine.No modification in clot firmness was observed.The present study seems to suggest that the commonly applied ratio equal to 1:1 (ratio of protamine to heparin) could be higher than needed with potential and hazardous impacts on the efficacy of the coagulation system.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Italy.

ABSTRACT

Introduction: Currently, a dose of protamine equal to 1 mg for each 100 units of heparin given is used to reverse the residual heparin activity following off-pump coronary artery bypass. We hypothesized that a 1:1 ratio (ratio of protamine to heparin) could be higher than necessary inducing post-operative disturbance of hemostasis.

Methods: Between January and March 2014 in 9 patients undergoing off-pump coronary artery bypass, we evaluated the effect of a dose of protamine equal to 1 mg per 100 units of heparin (Total Calculated Dose) on hemostasis as evaluated by means of thromboelastomery. Two data analyses were performed: the first after the administration of 2/3 of the Total Calculated Dose of protamine and the second after the administration of the Total Calculated Dose of protamine.

Results: We found that the administration of 2/3 of Total Calculated Dose of protamine was always able to reverse the anticoagulant effect of heparin and that a significant clotting time elongation was induced by the infusion of the second part of the Total Calculated Dose of protamine. No modification in clot firmness was observed.

Conclusions: The present study seems to suggest that the commonly applied ratio equal to 1:1 (ratio of protamine to heparin) could be higher than needed with potential and hazardous impacts on the efficacy of the coagulation system.

No MeSH data available.


Thromboelastomeric parameters at different stages of protamine administration.CT = Clotting Time; CFT = Clot Formation Time; α° = Alfa Angle; A10 = clot amplitude at 10 min after clotting time; A20 = clot amplitude at 20 min after clotting time; MCF = maximum clot firmness; TCD = Total Calculated Dose of protamine; s = seconds; mm = millimeters.
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Figure 005: Thromboelastomeric parameters at different stages of protamine administration.CT = Clotting Time; CFT = Clot Formation Time; α° = Alfa Angle; A10 = clot amplitude at 10 min after clotting time; A20 = clot amplitude at 20 min after clotting time; MCF = maximum clot firmness; TCD = Total Calculated Dose of protamine; s = seconds; mm = millimeters.


Impact of different dosage of protamine on heparin reversal during off-pump coronary artery bypass: a clinical study.

Suelzu S, Cossu A, Pala G, Portoghese M, Columbanu V, Sales G, Solinas L, Brazzi L - Heart Lung Vessel (2015)

Thromboelastomeric parameters at different stages of protamine administration.CT = Clotting Time; CFT = Clot Formation Time; α° = Alfa Angle; A10 = clot amplitude at 10 min after clotting time; A20 = clot amplitude at 20 min after clotting time; MCF = maximum clot firmness; TCD = Total Calculated Dose of protamine; s = seconds; mm = millimeters.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4593022&req=5

Figure 005: Thromboelastomeric parameters at different stages of protamine administration.CT = Clotting Time; CFT = Clot Formation Time; α° = Alfa Angle; A10 = clot amplitude at 10 min after clotting time; A20 = clot amplitude at 20 min after clotting time; MCF = maximum clot firmness; TCD = Total Calculated Dose of protamine; s = seconds; mm = millimeters.
Bottom Line: We found that the administration of 2/3 of Total Calculated Dose of protamine was always able to reverse the anticoagulant effect of heparin and that a significant clotting time elongation was induced by the infusion of the second part of the Total Calculated Dose of protamine.No modification in clot firmness was observed.The present study seems to suggest that the commonly applied ratio equal to 1:1 (ratio of protamine to heparin) could be higher than needed with potential and hazardous impacts on the efficacy of the coagulation system.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Italy.

ABSTRACT

Introduction: Currently, a dose of protamine equal to 1 mg for each 100 units of heparin given is used to reverse the residual heparin activity following off-pump coronary artery bypass. We hypothesized that a 1:1 ratio (ratio of protamine to heparin) could be higher than necessary inducing post-operative disturbance of hemostasis.

Methods: Between January and March 2014 in 9 patients undergoing off-pump coronary artery bypass, we evaluated the effect of a dose of protamine equal to 1 mg per 100 units of heparin (Total Calculated Dose) on hemostasis as evaluated by means of thromboelastomery. Two data analyses were performed: the first after the administration of 2/3 of the Total Calculated Dose of protamine and the second after the administration of the Total Calculated Dose of protamine.

Results: We found that the administration of 2/3 of Total Calculated Dose of protamine was always able to reverse the anticoagulant effect of heparin and that a significant clotting time elongation was induced by the infusion of the second part of the Total Calculated Dose of protamine. No modification in clot firmness was observed.

Conclusions: The present study seems to suggest that the commonly applied ratio equal to 1:1 (ratio of protamine to heparin) could be higher than needed with potential and hazardous impacts on the efficacy of the coagulation system.

No MeSH data available.