Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass
2015 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 1, 58-63 p.Article in journal (Refereed) Published
Objectives: 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 640âÂ±â230 (AU*min, meanâÂ±âSD) to 250âÂ±â160, TRAP 939âÂ±â293 to 472âÂ±â260, AA 307âÂ±â238 to 159âÂ±â143 and COL 1022âÂ±â350 to 506âÂ±â238 (all pâ<â0.001). Aggregation was also reduced after in vitro addition of protamine alone with activators ADP from 518âÂ±â173 to 384âÂ±â157 AU*min pâ<â0.001, and AA 449âÂ±â311 to 340âÂ±â285 (pâ<â0.01) and protamine combined with heparin (1:1 ratio) with activators ADP to 349âÂ±â160 and AA to 308âÂ±â260 (both pâ<â0.001); and COL from 586âÂ±â180 to 455âÂ±â172 (pâ<â0.05). Conclusions: Protamine given after CPB markedly reduces platelet aggregation. Protamine added in vitro also reduces platelet aggregation, by itself or in combination with heparin. Â© 2015 Taylor & Francis
Place, publisher, year, edition, pages
Taylor & Francis, 2015. Vol. 50, no 1, 58-63 p.
cardiopulmonary bypass; platelet aggregation; platelet function tests; protamine
Cardiac and Cardiovascular Systems
IdentifiersURN: urn:nbn:se:bth-11011DOI: 10.3109/14017431.2015.1099720ISI: 000365693900009ScopusID: 2-s2.0-84944936680OAI: oai:DiVA.org:bth-11011DiVA: diva2:873592