Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
February 13, 2009Anesthesia & Analgesia

Anticoagulation and Reversal Paradigms: Is Too Much of a Good Thing Bad?

View Full Paper
Ask AI
Bookmark
Share

Key result

Additional protamine administration significantly increased coagulation times compared to a single dose in patients after cardiopulmonary bypass, suggesting excess protamine may worsen coagulopathy.

Why the study?

Does thromboelastometry (ROTEM) accurately detect residual heparin to guide additional protamine administration in patients after coronary artery surgery with CPB?

Population

22 patients after coronary artery surgery with cardiopulmonary bypass (CPB)

Comparison

Additional protamine administered to patients… vs Single initial dose of protamine

Design

Editorial

Follow-up

30 min after protamine administration

Authors

JLJerrold H. LevyCardiac SurgeryKTKenichi A. TanakaUniversity of Maryland, Baltimore

Discussion

Loading...

Member takes

Implication

May warrant avoiding excess protamine to limit post-CPB coagulopathy; leaves open whether ROTEM-guided dosing improves outcomes.

Structured PICO

Does thromboelastometry (ROTEM) accurately detect residual heparin to guide additional protamine administration in patients after coronary artery surgery with CPB?

P
Population
22 patients undergoing coronary artery surgery with cardiopulmonary bypass evaluated for residual heparin levels and protamine effects using thromboelastometry.
I
Intervention
Additional protamine (70 μg/kg) administered to patients with an ACT above baseline and clinical signs of diffuse bleeding
C
Comparator
Single initial dose of protamine
O
Outcome
Detection of residual heparin levels using thromboelastometry (ROTEM) and anti-Xa activitysurrogate

ROTEM may be a useful bedside monitor to prevent unnecessary administration of excess protamine, which can contribute to coagulopathy after cardiac surgery.

Limitations

  • Patients were monitored for only 30 minutes after protamine administration, potentially missing late heparin rebound.
  • Small number of samples/patients.
  • In vitro coagulation studies using thromboelastometry require clinical outcomes to confirm findings.
  • Small number of samples (patients)
  • Monitored for only 30 min after protamine administration

Cite This Study

Levy et al. (2009) conducted an editorial in Coronary artery surgery with cardiopulmonary bypass (n=22). Additional protamine vs. Single protamine dose was evaluated on Coagulation times. Additional protamine administration significantly increased coagulation times compared to a single dose in patients after cardiopulmonary bypass, suggesting excess protamine may worsen coagulopathy.

synapsesocial.com/papers/6a9aaaa83548e71fe6b46471https://doi.org/10.1213/ane.0b013e31819614dd

Topics

Anticoagulation in AF
View Full Paper
Ask AI
Bookmark
Share

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Protamine Sulphate Inhibits Platelet Membrane Glycoprotein Ib-von Willebrand Factor Activity2000 · 56 citations
  2. 2Heparin Management Protocol for Cardiopulmonary Bypass1992 · 93 citations
  3. 3Protamine Reversal of Heparin Affects Platelet Aggregation and Activated Clotting Time After Cardiopulmonary Bypass1998 · 154 citations
  4. 4The Effects of Heparin, Protamine, and Heparin/Protamine Reversal on Platelet Function Under Conditions of Arterial Shear Stress2001 · 63 citations
  5. 5Detection of Protamine and Heparin After Termination of Cardiopulmonary Bypass by Thrombelastometry (ROTEM®): Results of a Pilot Study2009 · 76 citations