The beneficial effects of aminophylline administration on heparin reversal with protamine

Abstract

The aim of this study was to demonstrate the beneficial effects of aminophylline on protamine cardiotoxicity. Thirty-four patients were examined, 17 of whom received aminophylline 3 mg/kg before protamine administration, being the study group, while the other 17, being the control group, did not. All cardiac output and biochemical measurements were evaluated 5 min following protamine administration. The cAMP level was 43.4 +/- 3.51 pmol/ml in the study group and 18.7 +/- 2.98 in the control group (P < 0.0001) before protamine administration, while the oxygen extraction rate decreased from 49% to 44 +/- 2% in the control group, and from 51.2% to 47 +/- 3% in the study group (P < 0.03). The N-acetyl glucosaminidase value was 16.9 +/- 13.9 pmol/ml in the study group and 27.8 +/- 1.47 pmol/ml in the control group (P < 0.01), and myocardial lactate extraction was -0.20 +/- 0.03 in the control group and -0.07 +/- 0.07 in the study group (P < 0.001). The left ventricular stroke work index was 28.6 +/- 3.14 gm/m2 in the control group and 37 +/- 6.77 gm/m2 in the study group (P < 0.002). The findings of this study led us to conclude that the adverse effects of heparin neutralization using protamine can be relieved by aminophylline.

Beneficial Effects of Aminophylline on Ischemia-Reperfusion in Isolated Rabbit Heart

“…In previous studies, it was shown that aminophylline and prostacyclin protected the heart from protamine cardiotoxicity by elevating the cAMP level. 14,15 The most marked effects of aminophylline were observed during the early reperfusion period in terms of volume-pressure relationship and myocardial metabolism. In group 2 under maximal volume loading conditions, there was better contractile activity, increased oxidative activity, and less lactate release compared with the other groups, indicating reduced injury.…”

Effects of aminophylline on cytokines and pulmonary function in patients undergoing valve replacement

“…Compared with other agents such as aprotinin and steroids, aminophylline is safe and cost-effective, and has no risk of increasing potential infection, thromoembolism, and allergic reactions. In addition, aminophylline was also used to neutralize the adverse effect of protamine in cardiac operation [23], improved the sinus node dysfunction in heart transplantation [24]. We think that anti-inflammatory effect of aminophylline may also be beneficial for the patients undergoing open heart operation.…”

Aminophylline: Exploring Cardiovascular Benefits Versus Medical Malcontent

“…One of the lesser known benefits of aminophylline is the alleviation of side effects produced by protamine when used for heparin neutralization; the so-called protamine-induced cardiotoxicity. 35 Other reported beneficial effects of aminophylline have been the observed trend toward favorable diuresis in patients following major abdominal surgery, 36 its reversal of high-grade AV block during dipyridamole stress testing, 37 its benefit in cardiopulmonary resuscitation during cardiac arrest with asystole, 38 its improvement of functional renal impairment that occurs in patients with hepatic cirrhosis, 39 and the normalization of profound sinus node dysfunction that occurs in some patients following cardiac transplantation. 40 Other anecdotal reports of possible benefit have been in the alleviation of Cheyne-Stokes respiration, neonatal sleep apnea, bronchodilatory assistance in patients with advanced cystic fibrosis, the reduction of essential neurogenic tremor, and as adjunctive therapy in patients with chronic lymphocytic leukemia.…”