PMID- 25281041
OWN - NLM
STAT- MEDLINE
DCOM- 20151123
LR  - 20141004
IS  - 1532-8422 (Electronic)
IS  - 1053-0770 (Linking)
VI  - 28
IP  - 5
DP  - 2014 Oct
TI  - Protamine requirements in cardiac surgery: effect of changes in the heparin 
      reference standard.
PG  - 1227-32
LID - S1053-0770(14)00182-7 [pii]
LID - 10.1053/j.jvca.2014.04.024 [doi]
AB  - OBJECTIVE: UFH (unfractionated heparin) and protamine are integral to cardiac 
      surgery, and inappropriate dosing can predispose to coagulopathy and hemorrhage. 
      The FDA (Food and Drug Administration) recently has instituted changes to UFH 
      formulation and it is not known if this has influenced its susceptibility to 
      neutralization by protamine. Hence, the authors sought to compare 2 commercial 
      preparations of UFH (old and new) with regard to their neutralization by 
      protamine in patients undergoing cardiopulmonary bypass (CPB). DESIGN: 
      Prospective, observational, cohort study. SETTING: Tertiary care university 
      hospital and associated research laboratory PARTICIPANTS: Twenty adult patients 
      undergoing elective cardiac surgery with CPB. INTERVENTIONS: Blood samples were 
      drawn preinduction, prior to, and 5 and 30 minutes following protamine, and 0 and 
      2 hours after ICU admission. Protamine titration assays were conducted in vitro 
      on samples drawn prior to and following protamine administration. Anti-IIa and 
      anti-Xa activity were assayed in all samples. RESULTS: Anti-IIa and anti-Xa 
      activity were detected ubiquitously at all time points following CPB, and there 
      were no differences in susceptibility to protamine neutralization between the 2 
      groups. In vitro protamine titration studies revealed that anti-IIa was more 
      resistant to protamine neutralization compared to anti-Xa activity. CONCLUSIONS: 
      The 'old' and 'new' formulations of UFH evaluated in this study were similar in 
      their susceptibility to protamine neutralization. Circulating UFH is detected as 
      early as 5 minutes after protamine administration and anti-IIa is more resistant 
      to protamine neutralization as compared to anti-Xa activity. Further studies are 
      required to quantify the precise dose of protamine following CPB.
CI  - Crown Copyright (c) 2014. Published by Elsevier Inc. All rights reserved.
FAU - Taneja, Ravi
AU  - Taneja R
AD  - Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, 
      Western University, London, ON. Electronic address: Ravi.Taneja@lhsc.on.ca.
FAU - Berry, Leslie
AU  - Berry L
AD  - Department of Pediatrics, McMaster University, Thrombosis and Atherosclerosis 
      Research Institute, Hamilton, ON.
FAU - Pappu, Unnikrishnan
AU  - Pappu U
AD  - Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, 
      Western University, London, ON.
FAU - Stitt, Larry
AU  - Stitt L
AD  - Department of Epidemiology and Biostatistics, Western University, London, ON.
FAU - Sayal, Puneet
AU  - Sayal P
AD  - George Washington University, Washington, D.C.
FAU - Allen, Peter
AU  - Allen P
AD  - London Health Science Center, London, ON.
FAU - Hoogendoorn, Hugh
AU  - Hoogendoorn H
AD  - Hemostasis Reference Laboratory Inc., Hamilton, ON, Canada.
FAU - Chan, Anthony
AU  - Chan A
AD  - Department of Pediatrics, McMaster University, Thrombosis and Atherosclerosis 
      Research Institute, Hamilton, ON.
LA  - eng
SI  - ClinicalTrials.gov/NCT01675817
PT  - Clinical Trial
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - J Cardiothorac Vasc Anesth
JT  - Journal of cardiothoracic and vascular anesthesia
JID - 9110208
RN  - 0 (Protamines)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Animals
MH  - *Cardiac Surgical Procedures/trends
MH  - Chemistry, Pharmaceutical
MH  - Cohort Studies
MH  - Female
MH  - Heparin/blood/*standards/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pilot Projects
MH  - Prospective Studies
MH  - Protamines/blood/*standards/*therapeutic use
MH  - Reference Standards
MH  - Swine
OTO - NOTNLM
OT  - anti-Xa, anti-IIa
OT  - cardiopulmonary bypass
OT  - heparin, protamine
EDAT- 2014/10/05 06:00
MHDA- 2015/12/15 06:00
CRDT- 2014/10/05 06:00
PHST- 2014/01/28 00:00 [received]
PHST- 2014/10/05 06:00 [entrez]
PHST- 2014/10/05 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
AID - S1053-0770(14)00182-7 [pii]
AID - 10.1053/j.jvca.2014.04.024 [doi]
PST - ppublish
SO  - J Cardiothorac Vasc Anesth. 2014 Oct;28(5):1227-32. doi: 
      10.1053/j.jvca.2014.04.024.