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Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass
Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Blekinge Institute Technology, Sweden.
Linköping University, Department of Medical and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
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2016 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 1, 58-63 p.Article in journal (Refereed) PublishedText
Abstract [en]

Platelet dysfunction is an important cause of postoperative bleeding after cardiac surgery. Protamine is routinely used for reversal of heparin after cardiopulmonary bypass (CBP), but may affect platelet aggregation. We assessed changes in platelet function in relation to protamine administration. Design: Platelet aggregation was analyzed by impedance aggregometry before and after protamine administration in 25 adult cardiac surgery patients. Aggregation was also studied after in vitro addition of heparin and protamine. The activators adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used.Results: Platelet aggregation was reduced by approximately 50% after in vivo protamine administration; ADP 640 +/- 230 (AU*min, mean +/- SD) to 250 +/- 160, TRAP 939 +/- 293 to 472 +/- 260, AA 307 +/- 238 to 159 +/- 143 and COL 1022 +/- 350 to 506 +/- 238 (all p<0.001). Aggregation was also reduced after in vitro addition of protamine alone with activators ADP from 518 +/- 173 to 384 +/- 157 AU*min p<0.001, and AA 449 +/- 311 to 340 +/- 285 (p<0.01) and protamine combined with heparin (1:1 ratio) with activators ADP to 349 +/- 160 and AA to 308 +/- 260 (both p<0.001); and COL from 586 +/- 180 to 455 +/- 172 (p<0.05). Conclusions: Protamine given after CPB markedly reduces platelet aggregation. Protamine added in vitro also reduces platelet aggregation, by itself or in combination with heparin.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2016. Vol. 50, no 1, 58-63 p.
Keyword [en]
Cardiopulmonary bypass; platelet aggregation; platelet function tests; protamine
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-124094DOI: 10.3109/14017431.2015.1099720ISI: 000365693900009PubMedID: 26402229OAI: oai:DiVA.org:liu-124094DiVA: diva2:897214
Note

Funding Agencies|Blekinge Institute of Technology, Karlskrona; Department of Cardiothoracic Anaesthesiology and Intensive Care, County Council of Ostergotland [LIO-284621]

Available from: 2016-01-25 Created: 2016-01-19 Last updated: 2016-02-02

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Alfredsson, JoakimHåkansson, ErikSvedjeholm, RolfBerg, Sören
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Department of Anaesthesiology and Intensive Care in LinköpingDepartment of Medical and Health SciencesDepartment of Cardiology in LinköpingDivision of Cardiovascular MedicineFaculty of Medicine and Health Sciences
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Scandinavian Cardiovascular Journal
Surgery

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