The Effect of Differing Rates and Injection Sites on the Amount of Protamine Delivered Before Detection of Hemodynamic Alterations in Dogs

Morgan, M R; Monnet, Eric; Gaynor, James S.

doi:10.1053/jvet.2000.9136

Cited by 5 publications

(4 citation statements)

References 38 publications

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“…It is worth noting that PIH can develop at a low rate of 0.13 mg/kg/min in this study. In experimental dogs, the rapid infusion of 10 mg/kg/min greatly inhibits the circulatory system compared to a slow administration rate of 2.5 mg/kg/min [10,11]. Adverse hemodynamic reactions of protamine in humans are also less severe with a slow rate infusion for 15 min than with a 3 min method [20].…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic Effects of Protamine Infusion in Dogs with Myxomatous Mitral Valve Disease Undergoing Mitral Valvuloplasty

Yoshida

Matsuura

Mandour

et al. 2022

Veterinary Sciences

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Protamine, an antagonizing agent to heparin, is indispensable for dogs undergoing cardiopulmonary bypass. Protamine-induced hypotension (PIH) during cardiac anesthesia has been reported in humans. The purpose of this study was to describe the hemodynamic effect of protamine administration in dogs during cardiac surgery in clinical cases. Study design: Retrospective, clinical, cohort study. A total of 14 client-owned dogs who suffered heart failure due to medically uncontrolled myxomatous mitral valve disease (MMVD) were included in this study. The severity of MMVD was classified according to American College of Veterinary Internal Medicine staging (ACVIM: stage B2, C, D) and dogs undergoing mitral valve surgery. Records with clinical data for dogs treated between July 2019 to August 2020 were examined for age, sex, breed, body weight, concurrent diseases, hospitalization, anesthetic record, and mortality within 3 months after the operation. PIH was defined as mean arterial pressure (MAP) lowered by 20% of that before protamine infusion. To evaluate the effect of protamine on hemodynamic variables, each of the other values was compared with values at the beginning of protamine infusion. MAP decreased by 41.0 and 45.7% in two dogs (14.3%) compared with pressure before protamine infusion. Others did not show obvious alteration in hemodynamic variables. Epinephrine treatment alleviated hypotension in one dog. Another dog with systemic hypotension concomitant with elevated central venous pressure did not respond to epinephrine treatment and a reboot of extracorporeal circulation was required. Reheparinization and reinstitution of cardiopulmonary bypass successfully resuscitate the second dog. In conclusion, clinicians should alert the incidence of severe hypotension even with slow protamine infusion following canine cardiac surgery. This study also provides two effective treatments for catastrophic hypotension during protamine infusion.

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Section: Discussionmentioning

confidence: 99%

“…Protamine causes negative inotropic and systemic vasodilator effects in humans and experimental dogs [8,9]. According to reports on experimental dogs, 65% experienced systemic hypotension [10]. In another study, hypotension is less likely to occur when injected slowly than with rapid administration in dogs [11].…”

Section: Introductionmentioning

confidence: 97%

Hemodynamic Effects of Protamine Infusion in Dogs with Myxomatous Mitral Valve Disease Undergoing Mitral Valvuloplasty

Yoshida

Matsuura

Mandour

et al. 2022

Veterinary Sciences

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“…Protamine administration can induce severe side effects (hypotension and pulmonary vasoconstriction) in up to 70% of dogs previously treated with heparin and receiving an infusion of 2.5 mg/kg . The adverse reactions are minimized in dogs when protamine is administered via cephalic vein slowly (5 mg/min) . The effect of protamine is unknown in cats because of the limited studies available.…”

Section: Coagulationmentioning

confidence: 99%

Challenges of Cardiopulmonary Bypass—A Review of the Veterinary Literature

et al. 2012

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Cardiopulmonary bypass (CPB) has been used in veterinary medicine in experimental surgery and to address congenital and acquired diseases. We review the veterinary literature and expose common challenges of CPB in dogs and cats. Specifically, we describe the most specific elements of this technique in veterinary patients. The variety in animal size has made it difficult to standardize cannulation techniques, oxygenators, and priming volumes and solutions. The fact that one of the most common cardiovascular disorders, mitral valve disease, occurs predominantly in small dogs has limited the use of bypass in these patients because of the need for small, low prime oxygenators and pumps that have been unavailable until recently. Coagulation, hemostasis, and blood product availability have also represented important factors in the way CPB has developed over the years. The cost and the challenges in operating the bypass machine have represented substantial limitations in its broader use.

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“…16,17 For dogs, protamine doses range from 2.5 to 6 mg/kg. 18,19 Few studies have been conducted to evaluate the effects of protamine on global measures of clot formation and fibrinolysis in dogs. The circulating half-life of protamine in dogs has not been evaluated, to the authors' knowledge; however, the half-life in humans is short (7.4 minutes in healthy humans and 4.5 minutes in patients undergoing cardiac bypass).…”

mentioning

confidence: 99%

The effects of protamine sulfate on clot formation time and clot strength thromboelastography variables for canine blood samples

Bailey

Koenigshof²

2014

ajvr

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Results indicated protamine prolonged clot formation time and decreased overall clot strength in a dose-dependent manner; such effects may contribute to a hypocoagulable state in dogs. Kaolin-activated and nonactivated blood samples were appropriate for measurement of the effects of protamine on coagulation. Administration of protamine to reverse the effects of heparin should be performed with caution.

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The Effect of Differing Rates and Injection Sites on the Amount of Protamine Delivered Before Detection of Hemodynamic Alterations in Dogs

Abstract: We would recommend delivering protamine after cardiopulmonary bypass or vascular surgery through a peripheral venous route.

Cited by 5 publications

References 38 publications

Hemodynamic Effects of Protamine Infusion in Dogs with Myxomatous Mitral Valve Disease Undergoing Mitral Valvuloplasty

Hemodynamic Effects of Protamine Infusion in Dogs with Myxomatous Mitral Valve Disease Undergoing Mitral Valvuloplasty

Challenges of Cardiopulmonary Bypass—A Review of the Veterinary Literature

The effects of protamine sulfate on clot formation time and clot strength thromboelastography variables for canine blood samples

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