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Implementing a Statistical Model for Protamine Titration: Effects on Coagulation in Cardiac Surgical Patients
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
2017 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 31, no 2, 516-521 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To implement a statistical model for protamine titration. DESIGN: Prospective randomized trial. SETTING: University hospital. PARTICIPANTS: Sixty (n = 30+30) patients scheduled for elective coronary artery bypass surgery were randomly assigned to 2 groups. INTERVENTIONS: Protamine dose calculated according to an algorithm established from a statistical model or to a fixed protamine-heparin dose ratio (1:1). MEASUREMENTS AND MAIN RESULTS: Both groups demonstrated comparable patient demographics and intraoperative data. Coagulation effects were evaluated using rotational thromboelastometry. Using the statistical model reduced (p<0.01) the protamine dose from 426±43 mg to 251±66 mg, followed by significantly (p<0.01) shorter intrinsic clotting time (208±29 seconds versus 244±52 seconds) and stronger clot firmness (p = 0.01), and effects on indices of extrinsic or fibrinogen coagulation pathways were insignificant. Test of residual heparin was negative in all patients after protamine administration, aligned with insignificant (p = 0.27) intergroup heparinase-verified clotting time differences. CONCLUSIONS: The statistical model for protamine titration is clinically feasible and protects the patient from exposure to excessive doses of protamine, with advantageous effects on coagulation as measured using rotational thromboelastometry. Significance regarding clinical outcome is yet to be defined.

Place, publisher, year, edition, pages
2017. Vol. 31, no 2, 516-521 p.
Keyword [en]
cardiac surgery, cardiopulmonary bypass, heparin, protamine, statistical model
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:umu:diva-134742DOI: 10.1053/j.jvca.2016.07.018ISI: 000400794400018PubMedID: 27712970OAI: oai:DiVA.org:umu-134742DiVA: diva2:1094893
Available from: 2017-05-11 Created: 2017-05-11 Last updated: 2017-06-14Bibliographically approved

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Hällgren, OskarSvenmarker, StaffanAppelblad, Micael
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