Comparison of two protocols for heparin neutralization by protamine after cardiopulmonary bypass

Arén, Claes; Feddersen, Kurt; Rådegran, Kjell

doi:10.1016/s0022-5223(19)36216-6

Cited by 8 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There were no significant differences in any of the postoperative variables whether protamine was administered in fractionated doses or in a bolus dose. This is in contrast to the study by Aren and colleagues, 9 who found that a two-dose protocol of protamine administration significantly reduced the level of circulating plasma heparin. A single bolus appears to be the most simple and convenient way of giving protamine, although care should be taken not to infuse the drug too fast as rapid administration may cause arterial hypotension and pulmonary hypertension.…”

Section: Discussioncontrasting

confidence: 99%

Clinical Effects of Different Protamine Doses after Cardiopulmonary Bypass

Svenarud¹,

Øvrum²

2002

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

The optimal dose of protamine needed to reverse the anticoagulant effect of heparin after cardiopulmonary bypass is still not known. In this retrospective cohort study, we investigated 3 different dose regimes in 300 patients undergoing coronary artery bypass grafting. Group A patients (n = 100) were given protamine in the ratio of 1.3 mg to 1 mg heparin, group B patients (n = 100) were given 0.75 mg protamine to 1 mg heparin, and group C patients (n = 100) were given protamine in fractionated doses of 1 mg + 0.15 mg + 0.15 mg to 1 mg heparin. The groups were comparable in all major clinical and operative variables. The heparin dose was almost identical in the groups. The rate of red cell transfusion was significantly higher in group B than in the other groups. A similar but nonsignificant trend was observed in the incidence of resternotomy for postoperative bleeding, mediastinal drainage, and postoperative hemoglobin loss. The study demonstrates that a single bolus dose of 1.3 mg protamine to 1 mg heparin is safe and efficient for neutralizing heparin after cardiopulmonary bypass.

show abstract

Section: Discussioncontrasting

confidence: 99%

Clinical Effects of Different Protamine Doses after Cardiopulmonary Bypass

Svenarud¹,

Øvrum²

2002

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

show abstract

“…At the end of the procedure, the anticoagulant effect of heparin is reversed with protamine sulfate. 5 Heparin is most commonly derived from porcine intestinal mucosa, and several brands are commercially available. Hamilton Health Sciences recently switched from Hepalean (Organon Teknika, Toronto, Ontario, Canada) to Pharmaceutical Partners of Canada (PPC) heparin (PPC, Richmond Hill, Ontario, Canada) because the production of Hepalean was discontinued.…”

mentioning

confidence: 99%

Subtle differences in commercial heparins can have serious consequences for cardiopulmonary bypass patients: A randomized controlled trial

Arsenault

Paikin

Hirsh

et al. 2012

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Objective: To compare the potency, reversibility, and perioperative bleeding risk of Hepalean with those of PPC heparin. Methods: Because in vitro testing failed to detect differences in the potency or protamine reversibility of the 2 heparin preparations, we conducted a parallel group, single-center, double-blind, randomized, controlled trial to compare the anticoagulant effects of Hepalean to those of PPC heparin in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. Results: From June 1, 2011, to June 30, 2011, we randomly assigned 11 patients to receive PPC heparin and 10 to receive Hepalean. Despite similar initial doses of heparin, the median initial activated clotting time was numerically lower in the PPC heparin group than in the Hepalean group (median, 516.0 seconds; interquartile range, 481.0-633.0; vs median, 584.0 seconds, interquartile range, 520.0-629.0; P ¼ .418). Those given PPC heparin required a greater total heparin dose (median, 46,000.0 U; interquartile range, 39,500.0-60,000.0 vs median, 34,500.0 U; interquartile range, 32,250.0-37,000.0; P ¼ .011) and a greater dose of heparin per kilogram than those given Hepalean (median, 572.9 U/kg; interquartile range, 443.0-659.7 vs median, 401.1 U/kg; interquartile range, 400.0-419.4; P ¼ .003). The key secondary results included an increased median total protamine dose (median, 600.0 mg; interquartile range, 550.0-700.0; vs median, 500.0 mg; interquartile range, 425.0-542.5; P ¼ .026) and a trend toward increased chest tube output within 24 hours (median, 830.0 mL; interquartile range, 425.0-1135.0; vs median, 702.5 mL; interquartile range, 550.0-742.5; P ¼ .324). Conclusions: PPC heparin use was associated with greater heparin and protamine dose requirements than Hepalean. These findings indicate that heparin preparations are not interchangeable and suggest that a direct comparison of the potency with the brand in use is needed if a change is made to ensure that the agents exert similar anticoagulant effects in vivo. (

show abstract

“…A utilização de protocolos padronizados aplicados a todos os pacientes pode ser causa de complicações hemorrágicas, não sendo, por isso, recomendável por alguns autores, devido a que trabalhos demonstram a superioridade da anticoagulação controlada pelo TCA (2,20,21) . Por outro lado, JOBES et al (14) não acharam redução do sangramento ou de trans-fusões no pós-operatório entre os protocolos de dose fixa e doses monitoradas pela concentração de heparina no sangue, em virtude de o TCA ser prolongado pela hemodiluição, trombocitopenia, alteração da função plaquetária, agentes antifibrinolíticos como aprotinina (1,2,22,23) e hipotermia, independente da concentração de heparina circulante (1,2,7,(24)(25)(26) .…”

Section: Comentáriosunclassified