Key result
A reduced 0.5:1 protamine-to-heparin dosing ratio during off-pump coronary artery bypass grafting maintained effective hemostasis with no significant increase in total postoperative blood loss (463 ml vs 445 ml, p=0.28) while significantly improving post-reversal cardiac index.
Why the study?
To evaluate changes in hemodynamics and coagulation hemostasis, postoperative blood loss, and transfusion needs using reduced-dose protamine sulfate (0.5:1 ratio to heparin) in off-pump coronary artery bypass graft surgery.
Does a reduced dose of protamine sulfate (0.5:1 ratio) improve hemodynamics and prevent bleeding compared to a 1:1 ratio in patients undergoing off-pump CABG?
Cohort (n=70)
No
Does a reduced dose of protamine sulfate (0.5:1 ratio) improve hemodynamics and prevent bleeding compared to a 1:1 ratio in patients undergoing off-pump CABG?
A reduced protamine-to-heparin ratio of 0.5:1 during off-pump CABG provides better hemodynamic stability without increasing the risk of postoperative bleeding or transfusion requirements compared to a standard 1:1 ratio.
Answers are grounded in this paper and cite their sources.
Reduced protamine dosing showed no excess bleeding or transfusion needs in off-pump CABG; leaves open need for randomized trials before practice change.
Changes in hemodynamics and coagulation hemostasis during the use of protamine sulfate to neutralize heparin in a ratio of 0.5:1 in coronary artery bypass graft surgery have been studied. A comparative analysis of hemodynamic abnormalities, postoperative blood loss, and the need for blood transfusion in patients receiving protamine sulfate at the above dose has been carried out. The study included 70 patients who were successively operated on at the Shalimov National Institute of Surgery and Transplantation due to coronary heart disease, in whom coronary artery bypass grafting was performed on a working heart. The study group included 30 patients in whom heparin was neutralized with protamine in a ratio of 1:0.5. The comparison group included patients in whom heparin was neutralized with protamine in a ratio of 1:1. Statistical processing of the material was performed using the software StatPlus professional 2007. Both parametric and non-parametric methods of statistical analysis were used. The parametric method (Student’s t-test) was used to test the hypothesis of the equality of the mean values of two samples from different general sets. Pearson’s criterion was used to compare the two sets by qualitative features. Statistically significant differences in the obtained results were considered at p <0.05, which indicated a 95% probability of discrepancies. Changes in blood pressure, central venous pressure, electrocardiogram, cardiac output, cardiac index, coagulogram, complete blood count, biochemical blood test, electrolyte, acid-base and gas composition of blood during surgery and in the postoperative period were analyzed. The results showed that reduction in the dose of protamine to neutralize heparin is effective and safe in patients undergoing coronary artery bypass grafting. However, changes in hemodynamics and coagulogram in patients treated with 50% protamine dose were insignificant and did not increase perioperative blood loss and blood transfusion needs.
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Ap et al. (2022) conducted a cohort in Coronary heart disease (n=70). Protamine sulfate (0.5:1 ratio to heparin) vs. Protamine sulfate (1:1 ratio to heparin) was evaluated on Total postoperative blood loss (ml) (MD 18, p=0.28). A reduced 0.5:1 protamine-to-heparin dosing ratio during off-pump coronary artery bypass grafting maintained effective hemostasis with no significant increase in total postoperative blood loss (463 ml vs 445 ml, p=0.28) while significantly improving post-reversal cardiac index.
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