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A Pharmacokinetic Model for Protamine Dosing After Cardiopulmonary Bypass
| Content Provider | Scilit |
|---|---|
| Author | Meesters, Michael I. Veerhoek, Dennis de Jong, Jan R. Boer, Christa |
| Copyright Year | 2016 |
| Description | Journal: Journal of cardiothoracic and vascular anesthesia ObjectiveThis study investigated postoperative hemostasis of patients subjected to conventional protamine dosing compared with protamine dosing based on a pharmacokinetic (PK) model following cardiopulmonary bypass.DesignRetrospective case-control study.SettingTertiary university hospital.ParticipantsPatients undergoing elective cardiac surgery with cardiopulmonary bypass.InterventionsIn 56 patients, protamine was dosed in a fixed ratio (CD), while 62 patients received protamine based on the PK model.Measurements and Main ResultsThere was no difference in heparin administration (414±107 mg (CD) v 403±90 mg (PK); p = 0.54), whereas protamine dosing was considerably different with a protamine-to-heparin dosing ratio of 1.1±0.3 for the CD group and 0.5±0.1 for the PK group (p<0.001). The changes in activated coagulation time (ΔACT) values (ACT after protamine minus preoperative ACT;+17±77 s v+6±15 s; p = 0.31) were equal between groups. Yet, the thromboelastometric intrinsically activated coagulation test clotting time (CT; 250±76 s v 203±44 s; p<0.001) and intrinsically activated coagulation test without the heparin effect CT (275±105 v 198±32 s; p<0.001) were prolonged in the CD group. Median packed red blood cell transfusion (0 [0–2] v 0 [0–0]), fresh frozen plasma transfusion (1 [0–2] v 0 [0–0]), and platelet concentrate transfusion (0 [0–1] v 0 [0–0]) were different between the fixed ratio and PK group, respectively (all p<0.001).ConclusionsThis study showed that patient-tailored protamine dosing based on a PK model was associated with a reduction in protamine dosing, with better hemostatic test results when compared with fixed-ratio protamine dosing |
| Related Links | http://www.jcvaonline.com/article/S1053077016300829/pdf https://core.ac.uk/download/pdf/82475838.pdf |
| Ending Page | 1195 |
| Page Count | 6 |
| Starting Page | 1190 |
| ISSN | 10530770 |
| e-ISSN | 15328422 |
| DOI | 10.1053/j.jvca.2016.04.021 |
| Journal | Journal of cardiothoracic and vascular anesthesia |
| Issue Number | 5 |
| Volume Number | 30 |
| Language | English |
| Publisher | Elsevier BV |
| Publisher Date | 2016-10-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Journal of cardiothoracic and vascular anesthesia Critical Care Medicine Cardiac Surgery Cardiopulmonary Bypass |
| Content Type | Text |
| Resource Type | Article |
| Subject | Anesthesiology and Pain Medicine Cardiology and Cardiovascular Medicine |
