1. Impact of protamine dose on activated clotting time and thromboelastography in infants and small children undergoing cardiopulmonary bypass.
- Author
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Gautam NK, Schmitz ML, Harrison D, Zabala LM, Killebrew P, Belcher RH, Prodhan P, McKamie W, and Norvell DC
- Subjects
- Anticoagulants adverse effects, Anticoagulants therapeutic use, Cardiac Surgical Procedures, Case Management, Child, Preschool, Dose-Response Relationship, Drug, Female, Heparin adverse effects, Heparin therapeutic use, Humans, Infant, Infant, Newborn, Male, Regression Analysis, Cardiopulmonary Bypass, Heparin Antagonists administration & dosage, Heparin Antagonists pharmacology, Protamines administration & dosage, Protamines pharmacology, Thrombelastography drug effects, Whole Blood Coagulation Time
- Abstract
Objectives: To study the effect of two protamine-dosing strategies on activated clotting time (ACT) and thromboelastography (TEG)., Background: Protamine dosage based on neutralizing heparin present in the combined estimated blood volumes (EBVs) of the patient and cardiopulmonary bypass (CPB) pump may result in excess protamine and contributes toward a coagulopathy that can be detected by ACT and TEG in pediatric patients., Methods: A total of 100 pediatric patients 1 month to ≤5 years of age undergoing CPB were included in this retrospective before/after design study. Combined-EBV group consisted of 50 consecutive patients whose protamine dose was calculated to neutralize heparin in the combined EBVs of the patient and the pump. Pt-EBV group consisted of the next 50 consecutive patients whose protamine dose was calculated to neutralize heparin in the patient's EBV., Results: Baseline and postprotamine ACTs were similar between groups. Postprotamine heparin assay (Hepcon) showed the absence of residual heparin in both groups. Postprotamine kaolin-heparinase TEG showed that R was prolonged by 7.5 min in the Combined-EBV group compared with the Pt-EBV group (mean R of 20.17 vs. 12.4 min, respectively, P < 0.001). Increasing doses of protamine were associated with a corresponding, but nonlinear increase in R. There was no significant difference in the changes for K, alpha, and MA between the groups., Conclusion: Automated protamine titration with a protamine dosage based on Pt-EBV can adequately neutralize heparin as assessed by ACT while minimizing prolonging clot initiation time as measured by TEG., (© 2013 Blackwell Publishing Ltd.)
- Published
- 2013
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