Abstract | OBJECTIVES:
Heparin rebound, the reappearance of anticoagulant activity after adequate neutralization with protamine, is thought to contribute to excessive postoperative bleeding after cardiac surgery. We have previously demonstrated that a significant amount of heparin is bound nonspecifically to plasma proteins and is incompletely neutralized by protamine. The aim of this study was to investigate whether clinically important bleeding attributable to heparin rebound can be eliminated by infusion of small amounts of additional protamine for 6 hours postoperatively and whether this treatment can reduce mediastinal blood loss. METHODS: Three hundred patients undergoing elective cardiac surgery were randomized to receive either a continuous infusion of protamine sulphate (25 mg/h for 6 hours) postoperatively or saline placebo. Serial blood samples were obtained to measure thrombin clotting time and anti- factor Xa activity. Heparin bound nonspecifically to plasma proteins was measured after displacement with a chemically altered heparin with low affinity to antithrombin. Mediastinal blood loss and transfusion requirements were recorded. RESULTS: CONCLUSIONS: Postoperative protamine infusion was able to almost totally abolish heparin rebound. In the context of this study, protamine infusion resulted in reduced postoperative bleeding but the magnitude was insufficient to alter transfusion requirements.
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Authors | Kevin H T Teoh, Edward Young, Mary Helen Blackall, Robin S Roberts, Jack Hirsh |
Journal | The Journal of thoracic and cardiovascular surgery
(J Thorac Cardiovasc Surg)
Vol. 128
Issue 2
Pg. 211-9
(Aug 2004)
ISSN: 0022-5223 [Print] United States |
PMID | 15282457
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anticoagulants
- Blood Proteins
- Heparin Antagonists
- Protamines
- Heparin
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Topics |
- Anticoagulants
(adverse effects, metabolism)
- Blood Loss, Surgical
(statistics & numerical data)
- Blood Proteins
(metabolism)
- Blood Transfusion
(statistics & numerical data)
- Cardiopulmonary Bypass
- Double-Blind Method
- Female
- Heparin
(adverse effects, metabolism)
- Heparin Antagonists
(therapeutic use)
- Humans
- Male
- Middle Aged
- Postoperative Care
- Protamines
(therapeutic use)
- Protein Binding
- Time Factors
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