The effects of protamine overdose on coagulation parameters as measured by the thrombelastograph.
Eur J Anaesthesiol
; 27(7): 624-7, 2010 Jul.
Article
en En
| MEDLINE
| ID: mdl-20485179
ABSTRACT
BACKGROUND AND OBJECTIVE:
Protamine is routinely administered following cardiopulmonary bypass in order to neutralize the effects of heparin. An excess of protamine can contribute to coagulopathy, hence predisposing to bleeding with associated morbidity and mortality. Thromboelastography (TEG) is recognized as an invaluable bedside tool to detect coagulation parameters; however, the effects of protamine overdose on TEG parameters have not been fully established.METHODS:
Forty-six patients undergoing cardiac surgery using cardiopulmonary bypass were recruited in the study. Following heparinization, the patient's blood heparin level was measured using Hepcon HMS. Incremental doses of protamine [at a protamine-to-Hepcon-derived heparin ratio (PHR) of 11, 21 and 31] were added to patients' blood samples in vitro and four TEG coagulation parameters, including R (time to clot initiation), K (clot kinetics), alpha (clot kinetics) and maximum amplitude (ultimate clot strength), were monitored. Statistical analysis was performed using NCSS software.RESULTS:
Protamine caused dose-dependent worsening of coagulation parameters on TEG; K was significantly elevated, whereas alpha and maximum amplitude showed significant reduction (P < 0.001) compared with baseline at a PHR of 21 and 31, respectively. R was significantly prolonged compared with baseline (P < 0.001) at a PHR of 31.CONCLUSION:
Protamine adversely affects clot initiation time, clot kinetics and platelet function in a dose-dependent manner, which can predispose to bleeding.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Tromboelastografía
/
Coagulación Sanguínea
/
Heparina
/
Protaminas
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Hemorragia Posoperatoria
/
Procedimientos Quirúrgicos Cardíacos
/
Antagonistas de Heparina
/
Anticoagulantes
Límite:
Humans
Idioma:
En
Revista:
Eur J Anaesthesiol
Asunto de la revista:
ANESTESIOLOGIA
Año:
2010
Tipo del documento:
Article
País de afiliación:
Reino Unido