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Hemostatic effects of low‐dose protamine following cardiopulmonary bypass
Author(s) -
Miyashita Tetsuya,
Nakajima Toshito,
Hayashi Yukio,
Kuro Masakazu
Publication year - 2000
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/(sici)1096-8652(200006)64:2<112::aid-ajh7>3.0.co;2-n
Subject(s) - protamine , heparin , activated clotting time , cardiopulmonary bypass , medicine , platelet , anesthesia , coagulation , pharmacology , endocrinology
Twenty‐eight patients undergoing cardiac surgery were prospectively studied and were assigned to two groups. The patients received 0.8‐ (Group L) or 2.0‐fold (Group H) dose of protamine for the neutralization after cardiopulmonary bypass (CPB) which was determined by Hepcon HMS® assay system in which the reagent chamber containing the concentration of protamine that completely neutralized the heparin had the shortest clotting time. Mean dose of protamine was 1.60 ± 0.50 mg kg −1 in Group L, and 3.56 ± 1.48 mg kg −1 , respectively. Activated clotting times (ACT) were comparable between the two groups through this study period. In Group H, platelet counts significantly decreased to 69% of that before protamine administration, and plasma platelet factor 4 level significantly increased to approximate 2‐fold of that before protamine administration just after protamine administration, respectively. However, these phenomena were not observed in Group L. In addition, these hemostatic changes occurred transiently just after protamine administration. We conclude that the low‐dose protamine may prevent transient platelet depletion following CPB. Low‐dose protamine can neutralize anticoagulation effect of heparin sufficiently and may mitigate protamine‐induced platelet dysfunction. Am. J. Hematol. 64:112–115, 2000. © 2000 Wiley‐Liss, Inc.