Effects of Protamine Administration after Cardiopulmonary Bypass on Complement, Blood Elements, and the Hemodynamic State

Kirklin, James K.; Chenoweth, Dennis E.; Naftel, David C.; Blackstone, Eugene H.; Bitran, Daniel; Curd, John G.; Reves, J. G.; Samuelson, Paul N.

doi:10.1016/s0003-4975(10)62668-9

Cited by 231 publications

(67 citation statements)

References 18 publications

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“…Recently, a new score (the "Surgical Lung Injury Prediction score 2", SLIP-2) has been developed by Kor et al (7) to help identify surgical patients at risk for ARDS, based on the presence of nine independent predictors of ARDS [sepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20)(21)(22)(23)(24)(25)(26)(27)(28)(29) and >30 breaths/min), FiO 2 greater than 35%, and SpO 2 less than 95%].…”

Section: Ards Risk Assessment In Cardiac Surgerymentioning

confidence: 99%

“…The impact of redo cardiac surgery as a risk factor for developing ARDS has been elegantly investigated by Milot et al (9) who hypothesized a possible causative role of prior protamine sensitization, triggering a severe immune reaction at the end of CPB with protamineheparin complexes leading to the release of C3a and C4a. Of note, an immune reaction to protamine might be also due to IgE-mediated anaphylaxis, complement-mediated anaphylactoid reactions caused by heparin-protamine complexes or protamine-antiprotamine complexes or direct toxicity (21)(22)(23).…”

Section: Type Of Surgical Procedures and Risk Of Pulmonary Complicationsmentioning

confidence: 99%

“…This process can be furthermore amplified by low cardiac output, splanchnic hypoperfusion and transient gut mucosal ischemia causing bacterial endotoxin translocation (26,27). Notably, heparin administered during CPB needs to be neutralized at the end of the procedure by the use of protamine which is known to be able to activate the classical complement pathway (21). However, this inflammatory response is usually well tolerated by the majority of patients and additional explanation must be sought.…”

Section: Cpb and Ardsmentioning

confidence: 99%

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Acute respiratory distress syndrome after cardiac surgery

2016

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Acute respiratory distress syndrome (ARDS) is a leading cause of postoperative respiratory failure, with a mortality rate approaching 40% in the general population and 80% in the subset of patients undergoing cardiac surgery. The increased risk of ARDS in these patients has traditionally been associated with the use of cardiopulmonary bypass (CPB), the need for blood product transfusions, large volume shifts, mechanical ventilation and direct surgical insult. Indeed, the impact of ARDS in the cardiac population is substantial, affecting not only survival but also in-hospital length of stay and long-term physical and psychological morbidity. No patient undergoing cardiac surgery can be considered ARDS risk-free. Early identification of those at higher risk is crucial to warrant the adoption of both surgical and non-surgical specific preventative strategies. The present review focuses on epidemiology, risk assessment, pathophysiology, prevention and management of ARDS in the specific setting of patients undergoing cardiac surgery.

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Section: Ards Risk Assessment In Cardiac Surgerymentioning

confidence: 99%

Section: Type Of Surgical Procedures and Risk Of Pulmonary Complicationsmentioning

confidence: 99%

Section: Cpb and Ardsmentioning

confidence: 99%

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Acute respiratory distress syndrome after cardiac surgery

2016

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“…Böylece vazodilatasyon, hipotansiyon, kardiyak disfonksiyon, kapiller permeabilite artımı ve histamin salınımı olmaktadır (14,15). Bazı diabetik hastalarda ve deniz ürünleri allerjisi olanlarda anaflaktik reaksiyonlar da bildirilmiştir (16).…”

Section: Discussionunclassified

Açik Kalp Cerrahi̇si̇nde Anti̇koagülasyonun Sağlanmasinda Hepari̇n-Protami̇n Ti̇trasyonunun Önemi̇

Çorapçıoğlu¹

1997

Ankara Üniversitesi Tıp Fakültesi Mecmuası

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“…Consistent with this finding, our results show that it takes more than 20 times the clinical protamine dose (ie, 1.5 mg protamine per mg of heparin [21]) to completely neutralize the anti-Xa activity of the same mass of LMWH (Figure 3). Because protamine-induced toxicity appears to be dose-dependent (22), the need for such a high dose to alleviate the bleeding risk of LMWH may pose a major safety concern as to the use of protamine as the clinical antidote for LMWH. Thus, the requirement of a similar protamine dose of LMWP, which possesses a markedly reduced toxicity at this dose (as described later in this report), for LMWH reversal would yield significant clinical benefits.…”

Section: Neutralization Of Lmwhmentioning

confidence: 99%

Low molecular weight protamine (LMWP) as nontoxic heparin/low molecular weight heparin antidote (II): In vitro evaluation of efficacy and toxicity

et al. 2001

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Patients undergoing anticoagulation with heparin or low molecular weight heparin (LMWH) require a superior antidote that possesses more selective biological actions and a better safety profile than protamine. We had previously developed 2 low molecular weight protamine (LMWP) fractions (TDSP4 and TDSP5) from thermolysin-digested protamine as potential nontoxic, heparin-neutralizing agents. In this, the second article in this series, studies focused on in vitro evaluation of heparin/LMWHneutralizing efficacy and putative toxicity. These LMWP fractions, particularly TDSP5, were effective and fully capable of neutralizing a broad spectrum of heparin-induced anticoagulant activities (ie, aPTT, anti-Xa, and anti-IIa activities). Additionally, these LMWP fractions could neutralize the activities of commercial LMWH. As assessed by the anti-Xa assay, TDSP5 was as effective as, although less potent than, protamine in reversing the activity of MonoEmbolex (molecular weight 5000-7000) and 2 other different sizes (molecular weight of 3000 and 5000 d) of LMWH preparations. Furthermore, compared with protamine, TDSP5 exhibited a much-reduced toxicity and thus an improved safety profile, as reflected by its reduced ability to activate the complement system and cross-react with the antiprotamine antibodies, which are 2 primary indices of protamine toxicity.

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Effects of Protamine Administration after Cardiopulmonary Bypass on Complement, Blood Elements, and the Hemodynamic State

Cited by 231 publications

References 18 publications

Acute respiratory distress syndrome after cardiac surgery

Acute respiratory distress syndrome after cardiac surgery

Açik Kalp Cerrahi̇si̇nde Anti̇koagülasyonun Sağlanmasinda Hepari̇n-Protami̇n Ti̇trasyonunun Önemi̇

Low molecular weight protamine (LMWP) as nontoxic heparin/low molecular weight heparin antidote (II): In vitro evaluation of efficacy and toxicity

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