Protamine titration after cardiopulmonary bypass

Cardiorespiratory effects of protamine after cardiopulmonary bypass in man.

Utility of In Vitro Heparin and Protamine Titration for Dosing During Cardiopulmonary Bypass Surgery

Methods used to maintain a hemostatic balance during cardiopulmonary bypass surgery include the optimization of heparin and protamine dosing. Higher heparin doses have been associated with increased bleeding, while other studies have attributed reduced blood loss and transfusion requirements to lower protamine doses. We have evaluated the use of an in vitro heparin and protamine titration syste...

Complement activation during cardiopulmonary bypass by heparin-protamine interaction.

Circulating concentrations of split products of the third complement factor (C3c and C3d) were measured in five patients before, during and after cardiopulmonary bypass. In all patients, C3d concentrations increased significantly in samples obtained after the administration of protamine sulphate. Similarly, circulating C3c was seen only in those samples obtained immediately after protamine admi...

Successful cardiopulmonary bypass in diabetics with anaphylactoid reactions to protamine.

Two insulin dependent diabetics with previous anaphylactic like (anaphylactoid) reactions to protamine underwent successful cardiopulmonary bypass for coronary artery surgery. Platelet concentrates instead of protamine were used to neutralise their systemic heparinisation. In both cases the anaphylactoid reactions first became apparent after administration of protamine sulphate at the end of ca...

High incidence of antibodies to protamine and protamine/heparin complexes in patients undergoing cardiopulmonary bypass.

Protamine is routinely used to reverse heparin anticoagulation during cardiopulmonary bypass (CPB). Heparin interacts with protamine to form ultralarge complexes that are immunogenic in mice. We hypothesized that patients exposed to protamine and heparin during CPB will develop antibodies (Abs) to protamine/heparin (PRT/H) complexes that are capable of platelet activation. Specimens from a rece...