Avaliação da protamina na neutralização da heparina após circulação extracorpórea

Barroso, Roberto Cardoso; Mendonça, José Teles de; Carvalho, Michelle Garcêz de; Costa, Rika Kakuda da; Santos, José Edivaldo dos

doi:10.1590/s0102-76382002000100009

Cited by 2 publications

(3 citation statements)

References 20 publications

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“…The empirical infusion of extra doses of protamine in patients with bleeding can increase the blood loss [3]. However, additional doses of 30% of total protamine dose in the first hours of the postoperative period demonstrated to be efficient in the control of the rebound effect of heparin, reducing bleeding and the necessity of transfusions [25].…”

Section: Commentsmentioning

confidence: 99%

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Miana¹,

Atik²,

Moreira³

et al. 2004

Rev Bras Cir Cardiovasc

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Objective: To determine predictors of postoperative bleeding after cardiac surgery, in order to focus on preventive measures for high-risk populations.Methods: From October 2001 to March 2002, 411 consecutive adult cardiac surgery patients were prospectively studied, with the exception of those submitted to heart transplantation. In order to determine risk factors for postoperative bleeding, 20 preoperative, 17 operative and 6 postoperative variables were analyzed using univariate methods and multiple linear regression.Results: Operative procedures included coronary artery bypass grafting in 227 (55.2%) patients, valvar operations in 198 (48.2%), aortic surgery in 25 (6.1%) and combined procedures in 60 (14.6%). Cardiopulmonary bypass was used in 335 (81.5%) patients and anti-fibrinolysis agents in 148 (36%). The thirty-day mortality rate was 5.6% (23 patients). Mean 24-hour postoperative blood loss was 610 ± 500 mL (range 10-4900). Re-exploration for bleeding was required in 15 (3.7%) patients. Independent predictors of postoperative bleeding were emergency operations (p=0.049), postoperative metabolic acidosis (p=0.001), preoperative thrombocytopenia (p=0.034) and prolonged cardiopulmonary bypass (p=0.021).Conclusions: When possible, preoperative stabilization and correction of coagulation disturbances should be achieved in patients requiring urgent or emergent surgery and in those with thrombocytopenia. The duration of cardiopulmonary bypass should be minimized as long as this is practical. Postoperative metabolic acidosis must be actively corrected, especially the main determining causes. Descriptors

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Section: Commentsmentioning

confidence: 99%

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Miana¹,

Atik²,

Moreira³

et al. 2004

Rev Bras Cir Cardiovasc

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“…Protamine sulfate is routinely used during cardiac surgery to reverse the anticoagulation effects of heparin 1 . Protamine administration leads to increase expression of inflammatory factors that causes hemodynamical instability and ventilatory disorders in vulnerable patients 2–4 …”

Section: Introductionmentioning

confidence: 99%

“…1 Protamine administration leads to increase expression of inflammatory factors that causes hemodynamical instability and ventilatory disorders in vulnerable patients. [2][3][4] However, it has not been demonstrated whether protamine can alter immediate graft's flow during coronary artery bypass grafting surgery (CABG) surgeries.…”

mentioning

confidence: 99%

Transit‐time flow measurement parameters after protamine infusion in CABG surgeries

Dallan

Lisboa

Mejía

et al. 2022

Journal of Cardiac Surgery

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Objective The objective of this study is to evaluate protamine sulfate effects on graft's blood flow by comparing transit‐time flow measurement (TTFM) values before and after protamine administration. Methods This is an observational study with data collected between years 2018 and 2020. Immediate graft patency was evaluated using TTFM. Only patients with TTFM parameters registered before and after protamine infusion were included. The main three parameters studied were: mean graft flow (MGF), pulsatility index (PI), and diastolic flow (DF). In the first analysis, all conduits were evaluated regardless of the surgical technique used. In a second analysis, on‐pump and off‐pump groups were compared. Evaluated grafts were left internal thoracic artery, saphenous vein graft (SVG), radial artery, and right internal thoracic artery. Since SVG was numerically the most used graft, an exclusive analysis was created. Results Our study included 575 patients, resulting in a total of 1686 grafts, mean 2.93 grafts/patient. Off‐pump surgery was performed in 158 patients. Before protamine infusion, inadequate TTFM parameters were observed in 3.8% of grafts. Overall, after protamine administration, MGF decreased in all grafts, but its reduction was not statistically significant. PI values increased in the SVG and DF values reduced in LIMA grafts. SVG group analysis showed that after protamine PI values were higher in OM1 and RCA. DF values increased in RCA. The comparison between off and on‐pump surgeries, showed that in off‐pump cases TTFM measures did not present statistically significant differences. Conclusion Significant variations were observed in TTFM values before and after protamine administration. Although different, those values remained within the normal reference ranges. We recommend that flow measurement should be performed before protamine infusion.

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Avaliação da protamina na neutralização da heparina após circulação extracorpórea

Cited by 2 publications

References 20 publications

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Transit‐time flow measurement parameters after protamine infusion in CABG surgeries

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