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Activated platelet aggregation is transiently impaired also by a reduced dose of protamine
Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
Linkoping Univ, SWE.
Blekinge Hosp, SWE.
Linkoping Univ, SWE.
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(English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: Protamine reduces platelet aggregation after cardiopulmonary bypass (CPB). We studied the inhibitory effect of a reduced protamine dose, the duration of impaired platelet function and the possible correlation to postoperative bleeding. Design: Platelet function was assessed by impedance aggregometry in 30 patients undergoing cardiac surgery with CPB at baseline, before protamine administration, after 70% and 100% of the calculated protamine dose, after 20 minutes and at arrival to the intensive care unit. Adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used as activators. Blood loss was measured during operation and three hours after surgery. Results are presented as median (25th-75th percentile). Results: Platelet aggregation decreased markedly after the initial dose of protamine (70%) with all activators; ADP 89 (71-110) to 54 (35-78), TRAP 143 (116-167) to 109 (77-136), both p < .01; AA 25 (16-49) to 17 (12-24) and COL 92 (47-103) to 60 (38-81) U, both p < .05. No further decrease was seen after 100% protamine. The effect was transient and after twenty minutes platelet aggregation had started to recover; ADP 76 (54-106), TRAP 138 (95-158), AA 20 (10-35), COL 70 (51-93) U. Blood loss during operation correlated to aggregometry measured at baseline and after protaminization. Conclusions: Protamine after CPB induces a marked decrease in platelet aggregation already at a protamine-heparin ratio of 0.7:1. The impairment seems to be transient and recovery had started after 20 minutes.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD.
Keywords [en]
Cardiopulmonary bypass, platelet aggregation, platelet function test, protamine
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:bth-18659DOI: 10.1080/14017431.2019.1659396ISI: 000483657900001PubMedID: 31476919OAI: oai:DiVA.org:bth-18659DiVA, id: diva2:1351154
Available from: 2019-09-13 Created: 2019-09-13 Last updated: 2019-09-20Bibliographically approved

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Olsson, AnkiSanmartin Berglund, Johan

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