Abstract
Heparin and protamine are among the most frequently administered drugs during cardiac surgery with cardiopulmonary bypass. Heparin is mostly dosed to achieve full anticoagulation, which is monitored by the activated clotting time. In case of heparin resistance, alternative approaches should be considered, including the use of more sophisticated anticoagulation monitoring techniques. Protamine neutralizes heparin, but exerts anticoagulant effect itself when administered in the absence of heparin.
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Finley A, Greenberg C. Review article: heparin sensitivity and resistance: management during cardiopulmonary bypass. Anesth Analg. 2013;116:1210–22.
Găman AM, Găman GD. Deficiency of Antithrombin III (AT III) - case report and review of the literature. Curr Health Sci J. 2014;40:141–3.
Boer C, Meesters MI, Milojevic M, et al. 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2017;25:1–34.
Hoenicka M, Rupp P, Muller-Eising K, et al. Anticoagulation management during multivessel coronary artery bypass grafting: a randomized trial comparing individualized heparin management and conventional hemostasis management. J Thromb Haemost. 2015;13:1196–206.
Vonk AB, Veerhoek D, van den Brom CE, van Barneveld LJ, Boer C. Individualized heparin and protamine management improves rotational thromboelastometric parameters and postoperative hemostasis in valve surgery. J Cardiothorac Vasc Anesth. 2014;28:235–41.
Radulovic V, Laffin A, Hansson KM, Backlund E, Baghaei F, Jeppsson A. Heparin and protamine titration does not improve Haemostasis after cardiac surgery: a prospective randomized study. PLoS One. 2015;10:e0130271.
Boer C, Meesters MI, Veerhoek D, Vonk ABA. Anticoagulant and side-effects of protamine in cardiac surgery: a narrative review. Br J Anaesth. 2018;120:914–27.
Teoh KH, Young E, Bradley CA, Hirsh J. Heparin binding proteins. Contribution to heparin rebound after cardiopulmonary bypass. Circulation. 1993;88:II420–5.
Galeone A, Rotunno C, Guida P, et al. Monitoring incomplete heparin reversal and heparin rebound after cardiac surgery. J Cardiothorac Vasc Anesth. 2013;27:853–8.
Ichikawa J, Kodaka M, Nishiyama K, Hirasaki Y, Ozaki M, Komori M. Reappearance of circulating heparin in whole blood heparin concentration-based management does not correlate with postoperative bleeding after cardiac surgery. J Cardiothorac Vasc Anesth. 2014;28:1003–7.
Nielsen VG, Malayaman SN. Protamine sulfate: crouching clot or hidden hemorrhage? Anesth Analg. 2010;111:593–4.
Koster A, Borgermann J, Gummert J, Rudloff M, Zittermann A, Schirmer U. Protamine overdose and its impact on coagulation, bleeding, and transfusions after cardiopulmonary bypass: results of a randomized double-blind controlled pilot study. Clin Appl Thromb Hemost. 2014;20:290–5.
Meesters MI, Veerhoek D, de Lange F, et al. Effect of high or low protamine dosing on postoperative bleeding following heparin anticoagulation in cardiac surgery. A randomised clinical trial. Thromb Haemost. 2016;116:251–61.
Warkentin TE, Koster A. Bivalirudin: a review. Expert Opin Pharmacother. 2005;6:1349–71.
Dyke CM, Smedira NG, Koster A, et al. A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery with cardiopulmonary bypass: the EVOLUTION-ON study. J Thorac Cardiovasc Surg. 2006;131:533–9.
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Boer, C. (2019). Anticoagulation Management. In: von Heymann, C., Boer, C. (eds) Patient Blood Management in Cardiac Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-15342-7_11
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DOI: https://doi.org/10.1007/978-3-030-15342-7_11
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