A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products
Abstract OBJECTIVES In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown. METHODS In this be...
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| Veröffentlicht in: | Interactive cardiovascular and thoracic surgery 2020-09, Vol.31 (3), p.391-397 |
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| container_title | Interactive cardiovascular and thoracic surgery |
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| creator | Goedhart, Anne L M Gerritse, Bastiaan M Rettig, Thijs C D van Geldorp, Martijn W A Bramer, Sander van der Meer, Nardo J M Boonman-de Winter, Leandra J Scohy, Thierry V |
| description | Abstract
OBJECTIVES
In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown.
METHODS
In this before–after study, we evaluated the effect of a 0.6/1-protamine/heparin ratio implementation as of May 2017 versus a 0.8/1-protamine/heparin ratio on the 12-h postoperative blood loss and the amount of blood and blood component transfusions (fresh frozen plasma, packed red blood cells, fibrinogen concentrate, platelet concentrate and prothrombin complex concentrate) after cardiac surgery. A total of 2051 patients who underwent cardiac surgery requiring CPB between May 2016 and May 2018 were included.
RESULTS
In the 0.6/1-protamine/heparin ratio group, only 28.8% of the patients received blood component transfusion, compared to 37.9% of the patients in the 0.8/1-ratio group (P < 0.001). The median 12-h postoperative blood loss was 230 ml (interquartile range 140–320) in the 0.6/1-ratio group versus 260 ml (interquartile range 155–365) in the 0.8/1-ratio group (P < 0.001).
CONCLUSIONS
A 0.6/1-protamine/heparin ratio after weaning from CPB is associated with a significantly reduced 12-h postoperative blood loss and blood components transfusion. |
| doi_str_mv | 10.1093/icvts/ivaa109 |
| format | Article |
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OBJECTIVES
In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown.
METHODS
In this before–after study, we evaluated the effect of a 0.6/1-protamine/heparin ratio implementation as of May 2017 versus a 0.8/1-protamine/heparin ratio on the 12-h postoperative blood loss and the amount of blood and blood component transfusions (fresh frozen plasma, packed red blood cells, fibrinogen concentrate, platelet concentrate and prothrombin complex concentrate) after cardiac surgery. A total of 2051 patients who underwent cardiac surgery requiring CPB between May 2016 and May 2018 were included.
RESULTS
In the 0.6/1-protamine/heparin ratio group, only 28.8% of the patients received blood component transfusion, compared to 37.9% of the patients in the 0.8/1-ratio group (P < 0.001). The median 12-h postoperative blood loss was 230 ml (interquartile range 140–320) in the 0.6/1-ratio group versus 260 ml (interquartile range 155–365) in the 0.8/1-ratio group (P < 0.001).
CONCLUSIONS
A 0.6/1-protamine/heparin ratio after weaning from CPB is associated with a significantly reduced 12-h postoperative blood loss and blood components transfusion.</description><identifier>ISSN: 1569-9285</identifier><identifier>EISSN: 1569-9285</identifier><identifier>DOI: 10.1093/icvts/ivaa109</identifier><identifier>PMID: 32620960</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Anticoagulants - pharmacology ; Blood Coagulation - drug effects ; Blood Component Transfusion - trends ; Blood Loss, Surgical - prevention & control ; Cardiac Surgical Procedures ; Female ; Heparin - pharmacology ; Heparin Antagonists - pharmacology ; Humans ; Male ; Postoperative Hemorrhage - prevention & control ; Protamines - pharmacology</subject><ispartof>Interactive cardiovascular and thoracic surgery, 2020-09, Vol.31 (3), p.391-397</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c326t-93f9163fd70c7b257bdd0e048ee6a13e5c304208c5c9b86dd9f124264d5f10db3</citedby><cites>FETCH-LOGICAL-c326t-93f9163fd70c7b257bdd0e048ee6a13e5c304208c5c9b86dd9f124264d5f10db3</cites><orcidid>0000-0002-6815-7501 ; 0000-0003-1439-1914 ; 0000-0002-7520-5372</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32620960$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goedhart, Anne L M</creatorcontrib><creatorcontrib>Gerritse, Bastiaan M</creatorcontrib><creatorcontrib>Rettig, Thijs C D</creatorcontrib><creatorcontrib>van Geldorp, Martijn W A</creatorcontrib><creatorcontrib>Bramer, Sander</creatorcontrib><creatorcontrib>van der Meer, Nardo J M</creatorcontrib><creatorcontrib>Boonman-de Winter, Leandra J</creatorcontrib><creatorcontrib>Scohy, Thierry V</creatorcontrib><title>A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products</title><title>Interactive cardiovascular and thoracic surgery</title><addtitle>Interact Cardiovasc Thorac Surg</addtitle><description>Abstract
OBJECTIVES
In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown.
METHODS
In this before–after study, we evaluated the effect of a 0.6/1-protamine/heparin ratio implementation as of May 2017 versus a 0.8/1-protamine/heparin ratio on the 12-h postoperative blood loss and the amount of blood and blood component transfusions (fresh frozen plasma, packed red blood cells, fibrinogen concentrate, platelet concentrate and prothrombin complex concentrate) after cardiac surgery. A total of 2051 patients who underwent cardiac surgery requiring CPB between May 2016 and May 2018 were included.
RESULTS
In the 0.6/1-protamine/heparin ratio group, only 28.8% of the patients received blood component transfusion, compared to 37.9% of the patients in the 0.8/1-ratio group (P < 0.001). The median 12-h postoperative blood loss was 230 ml (interquartile range 140–320) in the 0.6/1-ratio group versus 260 ml (interquartile range 155–365) in the 0.8/1-ratio group (P < 0.001).
CONCLUSIONS
A 0.6/1-protamine/heparin ratio after weaning from CPB is associated with a significantly reduced 12-h postoperative blood loss and blood components transfusion.</description><subject>Aged</subject><subject>Anticoagulants - pharmacology</subject><subject>Blood Coagulation - drug effects</subject><subject>Blood Component Transfusion - trends</subject><subject>Blood Loss, Surgical - prevention & control</subject><subject>Cardiac Surgical Procedures</subject><subject>Female</subject><subject>Heparin - pharmacology</subject><subject>Heparin Antagonists - pharmacology</subject><subject>Humans</subject><subject>Male</subject><subject>Postoperative Hemorrhage - prevention & control</subject><subject>Protamines - pharmacology</subject><issn>1569-9285</issn><issn>1569-9285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkL1PwzAUxC0EolAYWZFHlrTPTuPGY1XxJVVigTlybIcamrj4OUX97zG0fGxM70766e7pCLlgMGIg87HTm4hjt1Eq2QNywgohM8nL4vCPHpBTxBcAJiGHYzLIueAgBZyQ1xmFkcjWwUfVus6Ol3atgutoUNF5moRWwTilKfbh2YYtdUgVotdORWvou4tLaqwOVmGyMagOmx6d76hvaL3y3tAUbnod8YwcNWqF9nx_h-Tp5vpxfpctHm7v57NFptNfMZN5I5nIGzMFPa15Ma2NAQuT0lqhWG4LncOEQ6kLLetSGCMbxidcTEzRMDB1PiRXu9xU_NZbjFXrUNvVSnXW91glGFjBuRAJzXaoDh4x2KZaB9eqsK0YVJ_7Vl_7Vvt9E3-5j-7r1pof-nvQ327fr__J-gCT9Idm</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Goedhart, Anne L M</creator><creator>Gerritse, Bastiaan M</creator><creator>Rettig, Thijs C D</creator><creator>van Geldorp, Martijn W A</creator><creator>Bramer, Sander</creator><creator>van der Meer, Nardo J M</creator><creator>Boonman-de Winter, Leandra J</creator><creator>Scohy, Thierry V</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6815-7501</orcidid><orcidid>https://orcid.org/0000-0003-1439-1914</orcidid><orcidid>https://orcid.org/0000-0002-7520-5372</orcidid></search><sort><creationdate>20200901</creationdate><title>A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products</title><author>Goedhart, Anne L M ; Gerritse, Bastiaan M ; Rettig, Thijs C D ; van Geldorp, Martijn W A ; Bramer, Sander ; van der Meer, Nardo J M ; Boonman-de Winter, Leandra J ; Scohy, Thierry V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-93f9163fd70c7b257bdd0e048ee6a13e5c304208c5c9b86dd9f124264d5f10db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Anticoagulants - pharmacology</topic><topic>Blood Coagulation - drug effects</topic><topic>Blood Component Transfusion - trends</topic><topic>Blood Loss, Surgical - prevention & control</topic><topic>Cardiac Surgical Procedures</topic><topic>Female</topic><topic>Heparin - pharmacology</topic><topic>Heparin Antagonists - pharmacology</topic><topic>Humans</topic><topic>Male</topic><topic>Postoperative Hemorrhage - prevention & control</topic><topic>Protamines - pharmacology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goedhart, Anne L M</creatorcontrib><creatorcontrib>Gerritse, Bastiaan M</creatorcontrib><creatorcontrib>Rettig, Thijs C D</creatorcontrib><creatorcontrib>van Geldorp, Martijn W A</creatorcontrib><creatorcontrib>Bramer, Sander</creatorcontrib><creatorcontrib>van der Meer, Nardo J M</creatorcontrib><creatorcontrib>Boonman-de Winter, Leandra J</creatorcontrib><creatorcontrib>Scohy, Thierry V</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Interactive cardiovascular and thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goedhart, Anne L M</au><au>Gerritse, Bastiaan M</au><au>Rettig, Thijs C D</au><au>van Geldorp, Martijn W A</au><au>Bramer, Sander</au><au>van der Meer, Nardo J M</au><au>Boonman-de Winter, Leandra J</au><au>Scohy, Thierry V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products</atitle><jtitle>Interactive cardiovascular and thoracic surgery</jtitle><addtitle>Interact Cardiovasc Thorac Surg</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>31</volume><issue>3</issue><spage>391</spage><epage>397</epage><pages>391-397</pages><issn>1569-9285</issn><eissn>1569-9285</eissn><abstract>Abstract
OBJECTIVES
In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown.
METHODS
In this before–after study, we evaluated the effect of a 0.6/1-protamine/heparin ratio implementation as of May 2017 versus a 0.8/1-protamine/heparin ratio on the 12-h postoperative blood loss and the amount of blood and blood component transfusions (fresh frozen plasma, packed red blood cells, fibrinogen concentrate, platelet concentrate and prothrombin complex concentrate) after cardiac surgery. A total of 2051 patients who underwent cardiac surgery requiring CPB between May 2016 and May 2018 were included.
RESULTS
In the 0.6/1-protamine/heparin ratio group, only 28.8% of the patients received blood component transfusion, compared to 37.9% of the patients in the 0.8/1-ratio group (P < 0.001). The median 12-h postoperative blood loss was 230 ml (interquartile range 140–320) in the 0.6/1-ratio group versus 260 ml (interquartile range 155–365) in the 0.8/1-ratio group (P < 0.001).
CONCLUSIONS
A 0.6/1-protamine/heparin ratio after weaning from CPB is associated with a significantly reduced 12-h postoperative blood loss and blood components transfusion.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>32620960</pmid><doi>10.1093/icvts/ivaa109</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6815-7501</orcidid><orcidid>https://orcid.org/0000-0003-1439-1914</orcidid><orcidid>https://orcid.org/0000-0002-7520-5372</orcidid></addata></record> |
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| source | Oxford Journals Open Access Collection; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Aged Anticoagulants - pharmacology Blood Coagulation - drug effects Blood Component Transfusion - trends Blood Loss, Surgical - prevention & control Cardiac Surgical Procedures Female Heparin - pharmacology Heparin Antagonists - pharmacology Humans Male Postoperative Hemorrhage - prevention & control Protamines - pharmacology |
| title | A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products |
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