Individualized heparin and protamine management improves rotational thromboelastometric parameters and postoperative hemostasis in valve surgery

Journal of Cardiothoracic and Vascular Anesthesia
Alexander B A VonkChrista Boer

Abstract

This study investigated whether a tailored approach to heparin and protamine management improved thromboelastometric parameters after cardiopulmonary bypass and reduced postoperative blood loss compared with activated coagulation time (ACT)-based fixed target heparin and protamine management. Randomized controlled study. Tertiary university hospital. Patients undergoing elective valve surgery (n = 38). Heparin and protamine management were based either on the ACT (n = 19) or hemostasis management system (HMS) measurements (n = 19; HMS Plus; Medtronic, Minneapolis, MN). The target ACT for initiation of cardiopulmonary bypass was 480 seconds. Study variables included rotational thromboelastometry EXTEM (extrinsic coagulation), HEPTEM (intrinsic coagulation with heparinase), and FIBTEM (fibrin part of clot formation) tests and 24-hour blood loss. The use of HMS reduced the median protamine-to-heparin ratio from 1.00 (1.00-1.00) to 0.62 (0.56-0.66; p<0.001). The ACT group showed a prolonged postbypass clotting time for both EXTEM (86 ± 13 seconds v 78 ± 10 seconds; p = 0.05) and HEPTEM (217 ± 58 seconds v 183 ± 24 seconds; p = 0.03) tests. There was a moderate correlation between protamine dosing with the EXTEM and HEPTEM clotting ...Continue Reading

References

May 1, 1983·American Journal of Hematology·R J Cobel-Geard, H I Hassouna
Jul 29, 1999·The Journal of Thoracic and Cardiovascular Surgery·O ShigetaT Mitsui
Feb 5, 2000·The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai Zasshi·T OhataH Matsuda
Jun 23, 2001·Journal of the American College of Cardiology·D W Losordo, J M Isner
Nov 28, 2001·The Annals of Thoracic Surgery·G J DespotisC W Hogue
Jun 22, 2006·Transfusion Medicine Reviews·Matthias HartmannKai Zacharowski
Aug 3, 2007·Interactive Cardiovascular and Thoracic Surgery·Kenneth Edward McLaughlin, Joel Dunning
Apr 1, 2008·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Joel DunningUNKNOWN EACTS Audit and Guidelines Committee
Feb 15, 2013·Anesthesia and Analgesia·Alan Finley, Charles Greenberg

❮ Previous
Next ❯

Citations

Oct 24, 2015·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Marco Ranucci
Jul 24, 2015·Thrombosis and Haemostasis·Michael Isaäc MeestersChrista Boer
Aug 4, 2015·The Review of Scientific Instruments·C R KrebsAmy L Oldenburg
Mar 31, 2015·Journal of Cardiothoracic and Vascular Anesthesia·Fredrik Ödling DavidssonStaffan Svenmarker
Apr 16, 2016·Expert Opinion on Drug Safety·Kasra AzarnoushLionel Camilleri
Aug 1, 2016·Journal of Cardiothoracic and Vascular Anesthesia·Yufeng ZhangZhinong Wang
Aug 6, 2016·Journal of Cardiothoracic and Vascular Anesthesia·Michael I MeestersChrista Boer
Oct 8, 2016·Journal of Cardiothoracic and Vascular Anesthesia·Oskar HällgrenMicael Appelblad
Jun 28, 2017·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Caroline Shams HakimiAnders Jeppsson
Oct 14, 2017·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Domenico PaganoChrista Boer
Oct 3, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Alexander WahbaUNKNOWN EACTS/EACTA/EBCP Committee Reviewers
Jul 6, 2020·Interactive Cardiovascular and Thoracic Surgery·Anne L M GoedhartThierry V Scohy
May 2, 2017·European Journal of Anaesthesiology·Sibylle A Kozek-LangeneckerKai Zacharowski
Feb 26, 2021·Asian Cardiovascular & Thoracic Annals·Wali R MurugeshUyyamballi S Dinesh Kumar
Jun 20, 2020·JACC. Cardiovascular Interventions·Baravan Al-KassouJan-Malte Sinning
Jul 3, 2021·Journal of Clinical Medicine·Valentina RancatiCarlo Marcucci

❮ Previous
Next ❯

Related Concepts

Related Feeds

Blood Clotting Disorders

Thrombophilia includes conditions with increased tendency for excessive blood clotting. Blood clotting occurs when the body has insufficient amounts of specialized proteins that make blood clot and stop bleeding. Here is the latest research on blood clotting disorders.

Anemia

Anemia develops when your blood lacks enough healthy red blood cells. Anemia of inflammation (AI, also called anemia of chronic disease) is a common, typically normocytic, normochromic anemia that is caused by an underlying inflammatory disease. Here is the latest research on anemia.