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Activated platelet aggregation is transiently impaired also by a reduced dose of protamine
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Blekinge Inst Technol, Sweden; Blekinge Hosp, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
Blekinge Hosp, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.ORCID iD: 0000-0002-9945-7486
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2019 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: Protamine reduces platelet aggregation after cardiopulmonary bypass (CPB). We studied the inhibitory effect of a reduced protamine dose, the duration of impaired platelet function and the possible correlation to postoperative bleeding. Design: Platelet function was assessed by impedance aggregometry in 30 patients undergoing cardiac surgery with CPB at baseline, before protamine administration, after 70% and 100% of the calculated protamine dose, after 20 minutes and at arrival to the intensive care unit. Adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used as activators. Blood loss was measured during operation and three hours after surgery. Results are presented as median (25th-75th percentile). Results: Platelet aggregation decreased markedly after the initial dose of protamine (70%) with all activators; ADP 89 (71-110) to 54 (35-78), TRAP 143 (116-167) to 109 (77-136), both p amp;lt; .01; AA 25 (16-49) to 17 (12-24) and COL 92 (47-103) to 60 (38-81) U, both p amp;lt; .05. No further decrease was seen after 100% protamine. The effect was transient and after twenty minutes platelet aggregation had started to recover; ADP 76 (54-106), TRAP 138 (95-158), AA 20 (10-35), COL 70 (51-93) U. Blood loss during operation correlated to aggregometry measured at baseline and after protaminization. Conclusions: Protamine after CPB induces a marked decrease in platelet aggregation already at a protamine-heparin ratio of 0.7:1. The impairment seems to be transient and recovery had started after 20 minutes.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2019.
Keywords [en]
Cardiopulmonary bypass; platelet aggregation; platelet function test; protamine
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-160417DOI: 10.1080/14017431.2019.1659396ISI: 000483657900001PubMedID: 31476919OAI: oai:DiVA.org:liu-160417DiVA, id: diva2:1353380
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-11-28

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Olsson, A.Alfredsson, JoakimSvedjeholm, RolfBerg, Sören
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Department of Medical and Health SciencesFaculty of Medicine and Health SciencesDivision of Cardiovascular MedicineDepartment of Cardiology in LinköpingDepartment of Thoracic and Vascular Surgery
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