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Year 2016 Vol. 24 No 4
GENERAL & SPECIAL SURGERY
D.V. OSIPENKO, A.G. KHRISTIN
ASSESSEMENT OF PROTAMINE EFFECT ON THROMBOELASTOMETRY PARAMETERS IN CARDIAC SURGERY PATIENTS IN VITRO
ME "Gomel Regional Clinical Cardiologic Center",
The Republic of Belarus
Objectives. To study the effects of protamine overdose on hemostatic parameters in vitro and to work out the criteria of protamine overdose using thromboelastometer ROTEM®.
Methods. Three groups of patients were formed randomly. The 10 µl of protamine solution (8,5 U) were added to the blood samples of the first group of patients. The concentration of protamine in the blood of the test sample was 1,57 U/ml. 10µl of sodium chloride solution were administrated to the blood samples of the second group. The third group (the control one) – no any additional drugs were introduced into the blood samples.
Results. In the first group of patients by Extem test the increase of the CT (104,5 s) was observed, which was higher by 37% (65,5 s) in the second group of patients and by 26% (77,0 s) in the third group. In the first group of patients by Intem test the increase of the CT values and CFT and also α angle change was determined compared with the second and third groups. The values of CT, CFT in the first group were higher than in the second group by 42% (210,0 s) and by 41% (71,5 s); the α angle in the first group (67,0º) was lower by 12% compared to the second group (75,5º). The values of CT, CFT in the first group were higher than in the third group by 50% (182,5 s) and by 23% (94,0 s); the α angle in the first group was lower by 7% compared to the third group (72,0º).
Conclusion. Protamine at a concentration of 1.57 U/ml has a strong hypocoagulation effect in vitro, which is manifested by specific changes in thromboelastometry ROTEM®
- Ostrovskii IuP, Valentiukevich AV, Zhigalkovich AS. Kardiokhirurgiia [Cardiosurgery]: sprav. Moscow, RF: Med lit; 2014. 512 p.
- Khensli FA, Martin DE, Grevli GP. Prakticheskaia kardioanesteziologiia [Practical cardioanesthesiology]: per s angl. 3-e izd. Moscow, RF: Med inform agentstvo; 2008. 1104 p.
- Miller R. Lebedinskii KM, red. Anesteziia Ronal'da Millera [Anesthesia Ronald Miller]: ruk v 4 t. Saint-Petersburg, RF: Edinitsa; 2015. 3328 p.
- Yamamoto T, Wolf HG, Sinzobahamvya N, Asfour B, Hraska V, Schindler E. Prolonged activated clotting time after protamine administration does not indicate residual heparinization after cardiopulmonary bypass in pediatric open heart surgery. Thorac Cardiovasc Surg. 2015 Aug;63(5):397-403. doi: 10.1055/s-0035-1554998.
- Mochizuki T, Olson PJ, Szlam F, Ramsay JG, Levy JH. Protamine reversal of heparin affects platelet aggregation and activated clotting time after cardiopulmonary bypass. Anesth Analg. 1998 Oct;87(4):781-85.
- Cammerer U, Dietrich W, Rampf T, Braun SL, Richter JA. The predictive value of modified computerized thromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery. Anesth Analg. 2003 Jan;96(1):51-7, table of contents.
- Lang T, Bauters A, Braun SL, Pötzsch B, von Pape KW, Kolde HJ, et al. Multi-centre investigation on reference ranges for ROTEM thromboelastometry. Blood Coagul Fibrinolysis. 2005 Jun;16(4):301-10.
- Mittermayr M, Velik-Salchner C, Stalzer B, Margreiter J, Klingler A, Streif W, et al. Detection of protamine and heparin after termination of cardiopulmonary bypass by thrombelastometry (ROTEM): results of a pilot study. Anesth Analg. 2009 Mar;108(3):743-50. doi: 10.1213/ane.0b013e31818657a3.
- Gertler R, Wiesner G, Tassani-Prell P, Braun SL, Martin K. Are the point-of-care diagnostics MULTIPLATE and ROTEM valid in the setting of high concentrations of heparin and its reversal with protamine? J Cardiothorac Vasc Anesth. 2011 Dec;25(6):981-6. doi: 10.1053/j.jvca.2010.11.020.
- Mittermayr M, Margreiter J, Velik-Salchner C, Klingler A, Streif W, Fries D, et al. Effects of protamine and heparin can be detected and easily differentiated by modified thrombelastography (Rotem): an in vitro study. Br J Anaesth. 2005 Sep;95(3):310-16.
- Ammar T, Fisher CF. The effects of heparinase 1 and protamine on platelet reactivity. Anesthesiology. 1997 Jun;86(6):1382-86.
- Nielsen VG1. Protamine enhances fibrinolysis by decreasing clot strength: role of tissue factor-initiated thrombin generation. Ann Thorac Surg. 2006 May;81(5):1720-27.
246046, Republic of Belarus, Gomel, Medical st., 4, ME "Gomel Regional Clinical Cardiology Center", department of anesthesiology and intensive care. Tel / fax: (0232) 43-48-01
Osipenko Dmitriy Vasilevich
Osipenko D.V. PhD, anesthesiologist, ME "Gomel Regional Clinical Cardiologic Center", department of anesthesiology and reanimation with intensive care.
Khristin A.G. Anesthesiologist, ME "Gomel Regional Clinical Cardiologic Center", department of anesthesiology and reanimation with intensive care.