Effect of Prolonged Hypothermic Cardiopulmonary Bypass, Heparin, and Protamine on Platelet: A Small-Group StudyFunding Rambam-Ofakim Research Program.
Cardiopulmonary bypass (CPB) is associated with platelet dysfunction (PD), an important cause of postoperative bleeding. The etiology of PD is not completely understood. We mapped the platelets' function during CPB to determine the etiology of PD. Platelets activation, measured by procaspase activating compound-1 and P-selectin expression (CD62P), after activation by adenosine diphosphate and thrombin receptor activator peptide, were decreased by protamine. Changes during CPB were insignificant. Platelet-leukocyte aggregation was increased by CPB but not by protamine. Platelet apoptosis marker, annexin V, was increased by protamine. Changes during CPB were insignificant. Our findings demonstrate that protamine given after CPB plays a central role in PD and count decrease.
Keywordscardiopulmonary bypass (CPB) - blood - coagulation/anticoagulation - hematology - anesthesia (includes related subject matter)
Received: 07 September 2020
Accepted: 19 October 2020
19 January 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Zilla P, Yacoub M, Zühlke L. et al. Global unmet needs in cardiac surgery. Glob Heart 2018; 13 (04) 293-303
- 2 Ranucci M, Pistuddi V, Di Dedda U, Menicanti L, De Vincentiis C, Baryshnikova E. Platelet function after cardiac surgery and its association with severe postoperative bleeding: the PLATFORM study. Platelets 2019; 30 (07) 908-914
- 3 Olsson A, Alfredsson J, Håkansson E, Svedjeholm R, Berglund J, Berg S. Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass. Scand Cardiovasc J 2016; 50 (01) 58-63
- 4 Adamik B, Kübler A, Gozdzik A, Gozdzik W. Prolonged cardiopulmonary bypass is a risk factor for intestinal ischaemic damage and endotoxaemia. Heart Lung Circ 2017; 26 (07) 717-723
- 5 Chalmers J, Pullan M, Mediratta N, Poullis M. A need for speed? Bypass time and outcomes after isolated aortic valve replacement surgery. Interact Cardiovasc Thorac Surg 2014; 19 (01) 21-26
- 6 Koster A, Faraoni D, Levy JH. Antifibrinolytic therapy for cardiac surgery: an update. Anesthesiology 2015; 123 (01) 214-221
- 7 Vinholt PJ, Hvas AM, Nybo M. An overview of platelet indices and methods for evaluating platelet function in thrombocytopenic patients. Eur J Haematol 2014; 92 (05) 367-376
- 8 Michelson AD, Barnard MR, Krueger LA, Frelinger III AL, Furman MI. Evaluation of platelet function by flow cytometry. Methods 2000; 21 (03) 259-270
- 9 Romlin BS, Söderlund F, Wåhlander H, Nilsson B, Baghaei F, Jeppsson A. Platelet count and function in paediatric cardiac surgery: a prospective observational study. Br J Anaesth 2014; 113 (05) 847-854
- 10 Olsson A, Alfredsson J, Thelander M, Svedjeholm R, Berglund JS, Berg S. Activated platelet aggregation is transiently impaired also by a reduced dose of protamine. Scand Cardiovasc J 2019; 53 (06) 355-360