Heparin and protamine titration do not improve haemostasis in cardiac surgical patients

Canadian Journal of Anaesthesia

Volumn 45, Issue 1, 1998, Pages 10-18

  Shore Lesserson, Linda ^a   Reich, David L ^a   DePerio, Marietta ^a  

^a MOUNT SINAI MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HEMOCHRON; HEPARIN; PROTAMINE; UNCLASSIFIED DRUG;

ARTICLE; BLEEDING; BLOOD CLOTTING; BLOOD CLOTTING TEST; CARDIOPULMONARY BYPASS; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; DOSE CALCULATION; DRUG DOSE; ERYTHROCYTE TRANSFUSION; FEMALE; HEMATOCRIT; HEMOSTASIS; HUMAN; IN VITRO STUDY; MAJOR CLINICAL STUDY; MALE; PARTIAL THROMBOPLASTIN TIME; POSTOPERATIVE HEMORRHAGE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL; THROMBIN TIME; THROMBOCYTE COUNT; TITRIMETRY;

EID: 0031918371     PISSN: 0832610X     EISSN: None     Source Type: Journal    
DOI: 10.1007/BF03011985     Document Type: Article

References (26)

1. Bull BS, Korpman RA, Huse WM, Briggs BD. Heparin therapy during extracorporeal circulation. I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg 1975; 69: 674-84.
2. Jobes DR, Aitken GL, Steven JM, Nicolson SC. Heparin sensitivity: influence of patient age, source of heparin and previous treatment. Anesthesiology 1993; 79: A89.
3. Despotis GJ, Filos KS, Zoys TN, Hogue CW Jr, Spitznagel E, Lappas DG. Factors associated with excessive post-operative blood loss and hemostatic transfusion requirements: a multivariate analysis in cardiac surgical patients. Anesth Analg 1996; 82: 13-21.
4. Gravlee GP, Haddon WS, Rothberger HK, et al. Heparin dosing and monitoring for cardiopulmonary bypass. A comparison of techniques with measurement of subclinical plasma coagulation. J Thorac Cardiovasc Surg 1990; 99: 518-27.
5. Horrow JC. Protamine: a review of its toxicity. Anesth Analg 1985; 64: 348-61.
6. Carr ME Jr, Carr SL. At high heparin concentrations, protamine concentrations which reverse heparin anticoagulant effects are insufficient to reverse heparin anti-platelet effects. Thromb Res 1994; 75: 617-30.
7. Dutton DA, Hothersall AP, McLaren AD, Taylor KM, Turner MA Protamine titration after cardiopulmonary bypass. Anaesthesia 1983; 38: 264-8.
8. Young JA, Kisker CT. Doty DB. Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer. Ann Thorac Surg 1978; 26: 231-40.
9. Gravlee GP, Whitaker CL, Mark LJ, Rogers AT, Royster RL, Harrison GA. Baseline activated coagulation time should be measured after surgical incision. Anesth Analg 1990; 71: 549-53.
10. Reich DL, Yanakakis MJ, Vela-Cantos FP, DePerio M, Jacobs E. Comparison of bedside coagulation monitor-ing tests with standard laboratory tests in patients after cardiac surgery. Anesth Analg 1993; 77: 673-9.
11. Package insert, Hemochron® Whole Blood Coagulation System, International Technidyne Inc., Edison, NJ: Thrombin Time and Heparin Thrombin Time, Rev 1/94.
12. Jobes DR, Aitken GL, Shaffer GW. Increased accuracy and precision of heparin and protamine dosing reduces blood loss and transfusion in patients undergoing primary cardiac operations. J Thorac Cardiovasc Surg 1995; 110: 36-45.
13. Despotis GJ, Joist JH, Hogue CW Jr, et al. The impact of heparin concentration and activated clotting time monitoring on blood conservation. J Thorac Cardiovasc Surg 1995; 110: 46-54.
14. Guffin AV, Dunbar RW, Kaplan JA, Bland JW Jr. Successful use of a reduced dose of protamine after cardiopulmonary bypass. Anesth Analg 1976; 55: 110-3.
15. Keeler JF, Shah MV, Hansbro SD. Protamine - the need to determine the dose. Comparison of a simple protamine titration method with an empirical dose regimen for reversal of heparinisation following cardiopulmonary bypass. Anaesthesia 1991; 46: 925-8.
16. DeLaria GA, Tyner JJ, Hayes CL, Armstrong BW. Heparin-protamine mismatch. A controllable factor in bleeding after open heart surgery. Arch Surg 1994; 129: 945-51.
17. Despotis GJ, Summerfield AL, Joist JH, et al. Comparison of activated coagulation time and whole blood heparin measurements with laboratory plasma anti-Xa heparin concentration in patients having cardiac operations. J Thorac Cardiovasc Surg 1994; 108: 1076-82.
18. Hardy J-F, Bélisle S. Robitaille D, Perrault J, Roy M, Gagnon L. Measurement of heparin concentration in whole blood with the Hepcon/HMS device does not agree with laboratory determination of plasma heparin concentration using a chromogenic substrate for activated factor X. J Thorac Cardiovasc Surg 1996; 112: 154-61.
19. Slaughter TF, LeBleu TH, Douglas JM Jr, Leslie JB, Parker JK, Greenberg CS. Characterization of prothrombin activation during cardiac surgery by hemostatic molecular markers. Anesthesiology 1994; 80: 520-6.
20. Gravlee GP, Rogers AT, Dudes LM, et al. Heparin management protocol for cardiopulmonary bypass influences postoperative heparin rebound but not bleeding. Anesthesiology 1992; 76: 393-401.
21. Kestin AS, Valeri CR, Khuri SF, et al. The platelet function defect of cardiopulmonary bypass. Blood 1993; 82: 107-17.
22. Khuri SF, Valeri CR, Loscalzo J, et al. Heparin causes platelet dysfunction and induces fibrinolysis before cardiopulmonary bypass. Ann Thorac Surg 1995; 60: 1008-14.
23. Boldt J, Schindler E, Osmer Ch, Wittstock M, Stertmann WA, Hempelmann G. Influence of different anticoagulation regimens on platelet function during cardiac surgery. Br J Anaesth 1994; 73: 639-44.
24. Esposito M, Culliford AT, Colvin SB, Thomas SJ, Lackner H, Spencer FC. Heparin resistance during cardiopulmonary bypass. The role of heparin pretreatment. J Thorac Cardiovasc Surg 1983; 85: 346-53.
25. Khuri SF, Wolfe JA, Josa M, et al. Hematologic changes during and after cardiopulmonary bypass and their relationship to the bleeding time and nonsurgical blood loss. J Thorac Cardiovasc Surg 1992; 104: 94-107.
26. Horrow JC, Van Riper DF, Strong MD, Grunewald KE, Parmet JL. The dose-response relationship of tranexamic acid. Anesthesiology 1995; 82: 383-92.