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protamine in cardiac surgery

Oskar Hällgren, Staffan Svenmarker, Micael Appelblad
OBJECTIVES: To implement a statistical model for protamine titration. DESIGN: Prospective randomized trial. SETTING: University hospital. PARTICIPANTS: Sixty (n = 30+30) patients scheduled for elective coronary artery bypass surgery were randomly assigned to 2 groups. INTERVENTIONS: Protamine dose calculated according to an algorithm established from a statistical model or to a fixed protamine-heparin dose ratio (1:1)...
July 17, 2016: Journal of Cardiothoracic and Vascular Anesthesia
James H Mehaffey, Damien J LaPar, Margret C Tracci, Kenneth J Cherry, John A Kern, Irving Kron, Gilbert R Upchurch
BACKGROUND: Carotid endarterectomy (CEA) is a commonly performed vascular operation. Yet, postoperative length of stay (LOS) varies greatly even within institutions. In this study, the morbidity and mortality, as well as financial impact of increased LOS were reviewed to establish modifiable factors associated with prolonged hospital stay. METHODS: The Society for Vascular Surgery Vascular Quality Initiative database was used to identify all patients undergoing primary CEA at a single institution between June 1, 2011 and November 28, 2014...
August 20, 2016: Annals of Vascular Surgery
Michael Fabbro, Jacob T Gutsche, Todd A Miano, John G Augoustides, Prakash A Patel
BACKGROUND: The inflated costs and documented deleterious effects of excess perioperative transfusion have led to the investigation of targeted coagulation factor replacement strategies. One particular coagulation factor of interest is factor I (fibrinogen). Hypofibrinogenemia is typically tested for using time-consuming standard laboratory assays. The thrombelastography (TEG)-based functional fibrinogen level (FLEV) provides an assessment of whole blood clot under platelet inhibition to report calculated fibrinogen levels in significantly less time...
September 2016: Anesthesia and Analgesia
M I Meesters, G Kuiper, A B A Vonk, S A Loer, C Boer
Point-of-care coagulation monitoring can be used for the guidance of haemostasis management. However, the influence of time on point-of-care prothrombin time testing following protamine administration after cardiopulmonary bypass has not been investigated. Bland-Altman and error grid analysis were used to analyse the level of agreement between prothrombin time measurements from point-of-care and laboratory tests before cardiopulmonary bypass, and then 3 min, 6 min and 10 min after protamine administration. Prothrombin times were expressed as International Normalised Ratios...
October 2016: Anaesthesia
Michael I Meesters, Dennis Veerhoek, Jan R de Jong, Christa Boer
OBJECTIVE: This study investigated postoperative hemostasis of patients subjected to conventional protamine dosing compared with protamine dosing based on a pharmacokinetic (PK) model following cardiopulmonary bypass. DESIGN: Retrospective case-control study. SETTING: Tertiary university hospital. PARTICIPANTS: Patients undergoing elective cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: In 56 patients, protamine was dosed in a fixed ratio (CD), while 62 patients received protamine based on the PK model...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Chikao Teramoto, Osamu Kawaguchi, Yoshimori Araki, Masaharu Yoshikawa, Wataru Uchida, Gennta Takemura, Naoki Makino
In patients with Marfan syndrome, cardiovascular complication due to aortic dissection represents the primary cause of death. Iatrogenic acute aortic dissection during cardiac surgery is a rare, but serious adverse event. A 51-year-old woman with Marfan syndrome underwent elective aortic surgery and mitral valve reconstruction surgery for the enlarged aortic root and severe mitral regurgitation. We replaced the aortic root and ascending aorta based on reimplantation technique. During subsequent mitral valve reconstruction, we found the heart pushed up from behind...
August 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Yufeng Zhang, Kai Liu, Wei Li, Qian Xue, Jiang Hong, Jibin Xu, Lihui Wu, Guangyu Ji, Jihong Sheng, Zhinong Wang
OBJECTIVE: To investigate the safety and efficacy of an adjusted regimen of heparin infusion in cardiopulmonary bypass (CPB) surgery in a Chinese population. DESIGN: Prospective, single-center, observational study. SETTING: University teaching hospital. PARTICIPANTS: Patients having cardiac surgery with CPB were selected for this study using the following criteria: 18 to 75 years of age, undergoing first-time cardiac surgery with conventional median sternotomy, aortic clamping time between 40 and 120 minutes, and preoperative routine blood tests showing normal liver, renal, and coagulation functions...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Ariane Willems, Veaceslav Savan, David Faraoni, Andrée De Ville, Laurence Rozen, Anne Demulder, Philippe Van der Linden
OBJECTIVE: Protamine is used to neutralize heparin after patient separation from cardiopulmonary bypass (CPB). Different bedside tests are used to monitor the adequacy of heparin neutralization. For this study, the interchangeability of the activated coagulation time (ACT) and thromboelastometry (ROTEM; Tem Innovations GmbH, Basel, Switzerland) clotting time (CT) ratios in children undergoing cardiac surgery was assessed. DESIGN: Single-center, retrospective, cohort study between September 2010 and January 2012...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Bartlomiej Kalaska, Kamil Kaminski, Joanna Miklosz, Shin-Ichi Yusa, Emilia Sokolowska, Agnieszka Blazejczyk, Joanna Wietrzyk, Irena Kasacka, Krzysztof Szczubialka, Dariusz Pawlak, Maria Nowakowska, Andrzej Mogielnicki
The parenteral anticoagulants may cause uncontrolled and life-threatening bleeding. Protamine, the only registered heparin antidote, is partially effective against low-molecular weight heparins, completely ineffective against fondaparinux and may cause unacceptable toxicity. Therefore, we aimed to develop a synthetic compound for safe and efficient neutralization of all parenteral anticoagulants. We synthesized pegylated PMAPTAC block copolymers, and then, we selected a lead heparin-binding copolymer (HBC)...
July 5, 2016: Translational Research: the Journal of Laboratory and Clinical Medicine
Camila Takao Lopes, Evelise Helena Fadini Reis Brunori, Agueda Maria Ruiz Zimmer Cavalcante, Sue Ann Moorhead, Juliana de Lima Lopes, Alba Lucia Bottura Leite de Barros
OBJECTIVE: To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. METHOD: A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression...
December 2015: Revista da Escola de Enfermagem da U S P
Caroline Van Aelbrouck, Sebastian Jorquera-Vasquez, Ingrid Beukinga, Olivier Pradier, Brigitte Ickx, Luc Barvais, Luc Van Obbergh, David Faraoni
This study sought to compare the effect of tranexamic acid (TXA) administration on cardiopulmonary bypass-induced platelet dysfunction in patients who received preoperative aspirin or not. We performed a prospective, randomized, double-blind pilot study, including patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Patients without aspirin interruption were enrolled in the 'group ASPIRIN' (n = 18) and those who had never been treated with aspirin were included in the 'group NO ASPIRIN' (n = 10)...
July 6, 2016: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
T Bakchoul, R Jouni, T E Warkentin
Protamine is widely used in medicine as a rapidly-acting antidote to heparin, particularly for reversing heparin anticoagulation after cardiac surgery. Protamine is also used as a stabilizing additive to certain preparations of insulin. Recent reports demonstrate that protamine and heparin form multimolecular complexes that result in high rates of immunization in post-cardiac surgery patients, particularly of immunoglobulin G (IgG) class antibodies; a subset of these anti-protamine/heparin IgG antibodies activates platelets through their FcγIIA (IgG) receptors...
September 2016: Journal of Thrombosis and Haemostasis: JTH
Michael I Meesters, Dennis Veerhoek, Fellery de Lange, Jacob-Willem de Vries, Jan R de Jong, Johannes W A Romijn, Hilde Kelchtermans, Dana Huskens, Robin van der Steeg, Pepijn W A Thomas, David T M Burtman, Laurentius J M van Barneveld, Alexander B A Vonk, Christa Boer
While experimental data state that protamine exerts intrinsic anticoagulation effects, protamine is still frequently overdosed for heparin neutralisation during cardiac surgery with cardiopulmonary bypass (CPB). Since comparative studies are lacking, we assessed the influence of two protamine-to-heparin dosing ratios on perioperative haemostasis and bleeding, and hypothesised that protamine overdosing impairs the coagulation status following cardiac surgery. In this open-label, multicentre, single-blinded, randomised controlled trial, patients undergoing on-pump coronary artery bypass graft surgery were assigned to a low (0...
August 1, 2016: Thrombosis and Haemostasis
Omer Dzemali, Michael T Ganter, Alicja Zientara, Kirk Graves, Renate Behr, Michele Genoni, Christoph K Hofer
BACKGROUND: Sonoclot is used to measure kaolin-based activated clotting time (kACT) for heparin management. Apart from measuring kACT, the device assesses the patient's coagulation status by glass bead-activated tests (gbACTs; measuring also clot rate [CR] and platelet function [PF]). Recently, a new version of the Sonoclot has been released, and the redesign may result in performance changes. The aim of this study was to evaluate and compare the performance of the new (S2) and the previous (S1) Sonoclot...
May 27, 2016: Clinical and Applied Thrombosis/hemostasis
Penny S Reynolds, Paul Middleton, Harry McCarthy, Bruce D Spiess
BACKGROUND: Viscoelastic thromboelastography tests such as TEG™ are now routine for assessing the coagulation status of cardiac surgery patients. We compared TEG™ with a new technology, sonic estimation of elasticity via resonance (SEER) sonorheometry, to compare measures of coagulation dynamics of whole blood and assess its potential for rapid, near-point-of-care monitoring of hemostasis during cardiac surgery. METHODS: Whole blood coagulation assessment of a prospective cohort of 50 cardiac surgery patients was performed using SEER sonorheometry and blood samples collected at 4 time points during cardiac surgery: baseline before anesthetic induction, during cardiopulmonary bypass on rewarming, 10 minutes after heparin reversal by protamine, and on patient transfer to the intensive care unit...
May 6, 2016: Anesthesia and Analgesia
Romy M W Kremers, Yvonne P J Bosch, Saartje Bloemen, Bas de Laat, Patrick W Weerwind, Bas Mochtar, Jos G Maessen, Rob J Wagenvoord, Raed Al Dieri, H Coenraad Hemker
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with blood loss and post-surgery thrombotic complications. The process of thrombin generation is disturbed during surgery with CPB because of haemodilution, coagulation factor consumption and heparin administration. We aimed to investigate the changes in thrombin generation during cardiac surgery and its underlying pro- and anticoagulant processes, and to explore the clinical consequences of these changes using in silico experimentation. Plasma was obtained from 29 patients undergoing surgery with CPB before heparinisation, after heparinisation, after haemodilution, and after protamine administration...
August 30, 2016: Thrombosis and Haemostasis
Bibek S Pannu, Devang K Sanghavi, Pramod K Guru, Dereddi Raja Reddy, Vivek N Iyer
Protamine sulfate is the only Food and Drug administration approved medication for reversal of intraoperative heparin-induced anticoagulation during cardiac and vascular surgeries. One of the rare side effects of protamine sulfate is an idiosyncratic reaction resulting in acute pulmonary hypertension (APH) and right ventricular (RV) failure occurring after protamine administration. These reactions are rare but catastrophic with high mortality. A 36-year-old female with severe congestive heart failure was undergoing cardiac transplant surgery...
March 2016: Indian Journal of Critical Care Medicine
Poonam Malhotra Kapoor, Ira Dhawan, Pawan Jain, Ujjwal Chowdhury
BACKGROUND: Lactate and central venous oxygen saturation (ScVO2) are well known biomarkers for adequacy of tissue oxygenation. Endothelin, an inflammatory marker has been associated with patient's nutritional status and degree of cyanosis. The aim of this study was to explore the hypothesis that lactate, ScVO2 and endothelin before induction may be predictive of mortality in pediatric cardiac surgery. METHODS: We conducted a prospective observational study of 150 pediatric (6 months to 12 years) patients who were posted for intracardiac repair for Tetralogy of Fallot and measured lactate, ScVO2 and endothelin before induction (T1), 20 minutes after protamine administration (T2) and 24 hours after admission to ICU (T3)...
April 2016: Annals of Cardiac Anaesthesia
Andrew Maslow, Arthur Bert, Arun Singh, Joseph Sweeney
OBJECTIVE: Point-of-care (POC) testing allows rapid assessment of hemoglobin (Hgb) and hematocrit (Hct) values. This study compared 3 POC testing devices--the Radical-7 pulse oximeter (Radical-7, Neuchȃtel, Switzerland), the i-STAT (Abbott Point of Care, Princeton, NJ), and the GEM 4000 (Instrumentation Laboratory, Bedford, MA)--to the hospital reference device, the UniCel DxH 800 (Beckman Coulter, Brea, CA) in cardiac surgery patients. DESIGN: Prospective study...
April 2016: Journal of Cardiothoracic and Vascular Anesthesia
Pradeep R Madhivathanan, Nick Fletcher, David Gaze, Rebekah Thomson, Venkatachalam Chandrasekaran, Nawaf Al-Subaie, Oswaldo Valencia, Vivek Sharma
INTRODUCTION: Endothelial Specific Molecule-1 or endocan is a novel biomarker associated with the development of acute lung injury (ALI) in response to a systemic inflammatory state such as trauma. Acute Respiratory Distress syndrome (ARDS), a severe form of ALI is a devastating complication that can occur following cardiac surgery due to risk factors such as the use of cardiopulmonary bypass (CPB) during surgery. In this study we examine the kinetics of endocan in the perioperative period in cardiac surgical patients...
July 2016: Cytokine
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