Protamine Dosage Based on Two Titrations Reduces Blood Loss After Valve Replacement Surgery: A Prospective, Double-Blinded, Randomized Study
Abstract Background Postoperative hemorrhage following cardiopulmonary bypass in heart valve replacement patients may be caused by a mismatch of protamine and heparin. We hypothesized that a 2-titration-guided protamine dose would reduce protamine-heparin mismatch and bleeding in those patients. Met...
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Published in | Canadian journal of cardiology Vol. 28; no. 5; pp. 547 - 552 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.09.2012
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Abstract | Abstract Background Postoperative hemorrhage following cardiopulmonary bypass in heart valve replacement patients may be caused by a mismatch of protamine and heparin. We hypothesized that a 2-titration-guided protamine dose would reduce protamine-heparin mismatch and bleeding in those patients. Methods Patients scheduled for elective cardiac valve replacement surgery (N = 60) were randomly divided into 3 groups. All patients received 2 titrations: the first at termination of cardiopulmonary bypass and the second at 5 minutes after the initial dose of protamine. In the control group, the initial protamine dose was based on the heparin dose received; the supplemental protamine dose was empirically determined. In the single-titration group, the initial dose was based on the first titration, while supplemental dose was empirically determined. In the 2-titration group, both initial and supplemental doses were based on titrations. Bleeding volumes were recorded from the time of first protamine dose to 24 hours after surgery. Results Most patients needed supplemental protamine according to second titrations. In the 2-titration group, 12 patients received supplemental protamine, whereas only 1 patient in the single-titration group and 6 in the control group received supplemental protamine ( P = 0.003). The blood loss was significantly less in the 2-titration group (526 ± 131 mL) than in the control group (730 ± 385 mL; P = 0.019). Conclusions A higher dosage of protamine based on 2 titrations reduced blood loss after surgery, supporting the hypothesis that inadequate dosage of protamine contributes to hemorrhage after valve replacement surgery. |
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AbstractList | Postoperative hemorrhage following cardiopulmonary bypass in heart valve replacement patients may be caused by a mismatch of protamine and heparin. We hypothesized that a 2-titration-guided protamine dose would reduce protamine-heparin mismatch and bleeding in those patients.
Patients scheduled for elective cardiac valve replacement surgery (N = 60) were randomly divided into 3 groups. All patients received 2 titrations: the first at termination of cardiopulmonary bypass and the second at 5 minutes after the initial dose of protamine. In the control group, the initial protamine dose was based on the heparin dose received; the supplemental protamine dose was empirically determined. In the single-titration group, the initial dose was based on the first titration, while supplemental dose was empirically determined. In the 2-titration group, both initial and supplemental doses were based on titrations. Bleeding volumes were recorded from the time of first protamine dose to 24 hours after surgery.
Most patients needed supplemental protamine according to second titrations. In the 2-titration group, 12 patients received supplemental protamine, whereas only 1 patient in the single-titration group and 6 in the control group received supplemental protamine (P = 0.003). The blood loss was significantly less in the 2-titration group (526 ± 131 mL) than in the control group (730 ± 385 mL; P = 0.019).
A higher dosage of protamine based on 2 titrations reduced blood loss after surgery, supporting the hypothesis that inadequate dosage of protamine contributes to hemorrhage after valve replacement surgery.
L'hémorragie postopératoire après le pontage cardiopulmonaire chez les patients subissant le remplacement d'une valvule cardiaque peut être causée par une mauvaise combinaison de la protamine et de l'héparine. Nous avons posé l'hypothèse qu'une dose de protamine déterminée par 2 titrages pourrait réduire la mauvaise combinaison protamine-héparine et l'hémorragie chez ces patients.
Les patients inscrits à une chirurgie élective de remplacement d'une valvule cardiaque (N = 60) ont été divisés au hasard en 3 groupes. Tous les patients ont eu 2 titrages : le premier à la fin du pontage cardiopulmonaire et le deuxième 5 minutes après la dose initiale de protamine. Dans le groupe témoin, la dose initiale de protamine était basée sur la dose d'héparine reçue; la dose supplémentaire de protamine était déterminée de manière empirique. Dans le groupe à titrage unique, la dose initiale était basée sur le premier titrage, tandis que la dose supplémentaire était déterminée de manière empirique. Dans le groupe à 2 titrages, les doses initiales et supplémentaires étaient basées sur les titrages. Les volumes hémorragiques ont été enregistrés de la première dose de protamine à la dose 24 heures après la chirurgie.
La plupart des patients ont eu besoin de protamine supplémentaire selon les deuxièmes titrages. Dans le groupe à 2 titrages, 12 patients ont reçu la protamine supplémentaire, alors que seul 1 patient du groupe à titrage unique et 6 du groupe témoin ont reçu la protamine supplémentaire (P = 0,003). La perte sanguine a été significativement inférieure dans le groupe à 2 titrages (526 ± 131 ml) que dans le groupe témoin (730 ± 385 ml; P = 0,019).
Un dosage plus élevé de protamine basé sur 2 titrages a réduit la perte sanguine après la chirurgie, ce qui soutient l'hypothèse qu'une posologie inadéquate de protamine contribue à l'hémorragie après la chirurgie de remplacement valvulaire. Postoperative hemorrhage following cardiopulmonary bypass in heart valve replacement patients may be caused by a mismatch of protamine and heparin. We hypothesized that a 2-titration-guided protamine dose would reduce protamine-heparin mismatch and bleeding in those patients. Patients scheduled for elective cardiac valve replacement surgery (N = 60) were randomly divided into 3 groups. All patients received 2 titrations: the first at termination of cardiopulmonary bypass and the second at 5 minutes after the initial dose of protamine. In the control group, the initial protamine dose was based on the heparin dose received; the supplemental protamine dose was empirically determined. In the single-titration group, the initial dose was based on the first titration, while supplemental dose was empirically determined. In the 2-titration group, both initial and supplemental doses were based on titrations. Bleeding volumes were recorded from the time of first protamine dose to 24 hours after surgery. Most patients needed supplemental protamine according to second titrations. In the 2-titration group, 12 patients received supplemental protamine, whereas only 1 patient in the single-titration group and 6 in the control group received supplemental protamine (P = 0.003). The blood loss was significantly less in the 2-titration group (526 ± 131 mL) than in the control group (730 ± 385 mL; P = 0.019). A higher dosage of protamine based on 2 titrations reduced blood loss after surgery, supporting the hypothesis that inadequate dosage of protamine contributes to hemorrhage after valve replacement surgery. BACKGROUNDPostoperative hemorrhage following cardiopulmonary bypass in heart valve replacement patients may be caused by a mismatch of protamine and heparin. We hypothesized that a 2-titration-guided protamine dose would reduce protamine-heparin mismatch and bleeding in those patients.METHODSPatients scheduled for elective cardiac valve replacement surgery (N = 60) were randomly divided into 3 groups. All patients received 2 titrations: the first at termination of cardiopulmonary bypass and the second at 5 minutes after the initial dose of protamine. In the control group, the initial protamine dose was based on the heparin dose received; the supplemental protamine dose was empirically determined. In the single-titration group, the initial dose was based on the first titration, while supplemental dose was empirically determined. In the 2-titration group, both initial and supplemental doses were based on titrations. Bleeding volumes were recorded from the time of first protamine dose to 24 hours after surgery.RESULTSMost patients needed supplemental protamine according to second titrations. In the 2-titration group, 12 patients received supplemental protamine, whereas only 1 patient in the single-titration group and 6 in the control group received supplemental protamine (P = 0.003). The blood loss was significantly less in the 2-titration group (526 ± 131 mL) than in the control group (730 ± 385 mL; P = 0.019).CONCLUSIONSA higher dosage of protamine based on 2 titrations reduced blood loss after surgery, supporting the hypothesis that inadequate dosage of protamine contributes to hemorrhage after valve replacement surgery. Abstract Background Postoperative hemorrhage following cardiopulmonary bypass in heart valve replacement patients may be caused by a mismatch of protamine and heparin. We hypothesized that a 2-titration-guided protamine dose would reduce protamine-heparin mismatch and bleeding in those patients. Methods Patients scheduled for elective cardiac valve replacement surgery (N = 60) were randomly divided into 3 groups. All patients received 2 titrations: the first at termination of cardiopulmonary bypass and the second at 5 minutes after the initial dose of protamine. In the control group, the initial protamine dose was based on the heparin dose received; the supplemental protamine dose was empirically determined. In the single-titration group, the initial dose was based on the first titration, while supplemental dose was empirically determined. In the 2-titration group, both initial and supplemental doses were based on titrations. Bleeding volumes were recorded from the time of first protamine dose to 24 hours after surgery. Results Most patients needed supplemental protamine according to second titrations. In the 2-titration group, 12 patients received supplemental protamine, whereas only 1 patient in the single-titration group and 6 in the control group received supplemental protamine ( P = 0.003). The blood loss was significantly less in the 2-titration group (526 ± 131 mL) than in the control group (730 ± 385 mL; P = 0.019). Conclusions A higher dosage of protamine based on 2 titrations reduced blood loss after surgery, supporting the hypothesis that inadequate dosage of protamine contributes to hemorrhage after valve replacement surgery. |
Author | Liu, Xiang, PhD Guo, Yan, MD Tang, Jiali, MD Liu, Jin, MD, PhD Du, Lei, MD, PhD Liu, Raphael C., MD Guo, Yingqiang, MD |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22633184$$D View this record in MEDLINE/PubMed |
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Snippet | Abstract Background Postoperative hemorrhage following cardiopulmonary bypass in heart valve replacement patients may be caused by a mismatch of protamine and... Postoperative hemorrhage following cardiopulmonary bypass in heart valve replacement patients may be caused by a mismatch of protamine and heparin. We... BACKGROUNDPostoperative hemorrhage following cardiopulmonary bypass in heart valve replacement patients may be caused by a mismatch of protamine and heparin.... |
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SubjectTerms | Adult Cardiopulmonary Bypass - adverse effects Cardiopulmonary Bypass - methods Cardiovascular Chi-Square Distribution Dose-Response Relationship, Drug Double-Blind Method Drug Administration Schedule Female Follow-Up Studies Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - methods Heparin - administration & dosage Heparin - adverse effects Heparin Antagonists - administration & dosage Humans Male Middle Aged Postoperative Hemorrhage - drug therapy Postoperative Hemorrhage - prevention & control Prospective Studies Protamines - administration & dosage Reference Values Risk Assessment Treatment Outcome |
Title | Protamine Dosage Based on Two Titrations Reduces Blood Loss After Valve Replacement Surgery: A Prospective, Double-Blinded, Randomized Study |
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