Impact of protamine dose on activated clotting time and thromboelastography in infants and small children undergoing cardiopulmonary bypass

“…The most widely used polyions in pharmaceutical applications are heparin and protamine. − Protamine is an arginine-rich polypeptide used as an antidote to the anticoagulant heparin in medical procedures where it binds strongly to heparin forming a neutral complex . Since large heparin doses can lead to bleeding complications, and protamine overdose is known to cause complement activation and other toxic effects in patients, monitoring of their concentration in blood is potentially quite useful. − In consideration that the pulstrode response is also governed by the presence of sodium or chloride ions, experiments were carried out to determine both heparin and protamine in a FIA mode in which a physiological level of NaCl background is present. Experiments using samples made in a 10 mM phosphate buffer, pH 7.4, with 100 mM NaCl and using this same buffer as the carrier stream were therefore performed.…”

Section: Resultsmentioning

confidence: 99%

Polyion Selective Polymeric Membrane-Based Pulstrode as a Detector in Flow-Injection Analysis

et al. 2014

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A method for the detection of polyions using fully reversible polyion selective polymeric membrane type pulstrodes as detectors in a flow-injection analysis (FIA) system is examined. The detection electrode consists of a plasticized polymeric membrane doped with 10 wt % of tridodecylmethylammonium-dinonylnaphthalene sulfonate (TDMA/DNNS) ion-exchanger salt. The pulse sequence used involves a short (1 s) galvanostatic pulse, an open-circuit pulse (0.5 s) during which the EMF of the cell is measured, and a longer (15 s) potentiostatic pulse to return the membrane to its original chemical composition. It is shown that total pulse sequence times can be optimized to yield reproducible real-time detection of injected samples of protamine and heparin at up to 20 samples/h. Further, it is shown that the same membrane detector can be employed for FIA detection of both polycations at levels ≥10 μg/mL and polyanions at levels of ≥40 μg/mL by changing the direction of the galvanostatic pulse. The methodology described may also be applicable in the detection of polyionic species at low levels in other flowing configurations, such as in liquid chromatography and capillary electrophoresis.

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“…The HMS‐calculated heparin concentration may improve and optimize heparin responsiveness during CPB, especially in patients who may be deficient in AT such as children with CCHD and secondary erythrocytosis. It also targets a smaller protamine dose than predicted by traditional weight‐based heparin protocols which is important because an excess of unbound protamine also has significant anticoagulant effects .…”

Section: Introductionmentioning

confidence: 99%

Cyanotic congenital heart disease (CCHD): focus on hypoxemia, secondary erythrocytosis, and coagulation alterations

Zabala

Guzzetta

2015

Pediatric Anesthesia

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Children with cyanotic congenital heart disease (CCHD) have complex alterations in their whole blood composition and coagulation profile due to long-standing hypoxemia. Secondary erythrocytosis is an associated physiological response intended to increase circulating red blood cells and oxygen carrying capacity. However, this response is frequently offset by an increase in whole blood viscosity that paradoxically reduces blood flow and tissue perfusion. In addition, the accompanying reduction in plasma volume leads to significant deficiencies in multiple coagulation proteins including platelets, fibrinogen and other clotting factors. On the one hand, these patients may suffer from severe hyperviscosity and subclinical 'sludging' in the peripheral vasculature with an increased risk of thrombosis. On the other hand, they are at an increased risk for postoperative hemorrhage due to a complex derangement in their hemostatic profile. Anesthesiologists caring for children with CCHD and secondary erythrocytosis need to understand the pathophysiology of these alterations and be aware of available strategies that lessen the risk of bleeding and/or thrombosis. The aim of this review is to provide an updated analysis of the systemic effects of long-standing hypoxemia in children with primary congenital heart disease with a specific focus on secondary erythrocytosis and hemostasis.

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Impact of protamine dose on activated clotting time and thromboelastography in infants and small children undergoing cardiopulmonary bypass

Abstract: Automated protamine titration with a protamine dosage based on Pt-EBV can adequately neutralize heparin as assessed by ACT while minimizing prolonging clot initiation time as measured by TEG.

Cited by 19 publications

References 37 publications

Kaolin‐activated thromboelastography and standard coagulation assays in cyanotic and acyanotic infants undergoing complex cardiac surgery: a prospective cohort study

Kaolin‐activated thromboelastography and standard coagulation assays in cyanotic and acyanotic infants undergoing complex cardiac surgery: a prospective cohort study

Polyion Selective Polymeric Membrane-Based Pulstrode as a Detector in Flow-Injection Analysis

Cyanotic congenital heart disease (CCHD): focus on hypoxemia, secondary erythrocytosis, and coagulation alterations

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