title: ATP reduces blood loss produced by heparin in cardiopulmonary bypass operations.
abstract: It was previously shown that topical application of heparin produces enhanced bleeding from small vessels and capillaries. Adenosine triphosphate at low concentrations is able to dislodge heparin bound to a receptor, counteracting its antihemostatic activity. These results led us to measure the amounts of heparin remaining in the blood after protamine neutralization of the patients subjected to cardiopulmonary bypass operation and to test the topical application of the nucleotide. Adenosine triphosphate at a concentration of 10(-4) mol/L significantly reduces the blood volume (p < 0.005) oozed from the thoracic cavity of the patients (mean, 288 +/- 188 mL) when compared with controls (mean, 564 +/- 288 mL). Adenosine triphosphate at 5 x 10(-5) mol/L reduces the blood loss to a mean of 370 +/- 155 mL in the patients tested (p < 0.08). About 10% of heparin of low molecular weight (< or = 6.0 Kda), which is also found in the oozed blood, is not neutralized by protamine. We suggest that the excessive blood loss of the patients is probably produced by low molecular weight heparins in the commercial preparations that are not neutralized by protamine.
authors.affiliation: Disciplina de Cirurgia Cardiovascular, Escola Paulista de Medicina, São Paulo, Brazil.
authors.forename: H V
authors.initials: HV
authors.lastname: Garcia
authors.forename: E
authors.initials: E
authors.lastname: Buffolo
authors.forename: H B
authors.initials: HB
authors.lastname: Nader
authors.forename: C P
authors.initials: CP
authors.lastname: Dietrich
mesh_terms: D000255:Adenosine Triphosphate / Q000494:pharmacology / Q000627:therapeutic use*; D000287:Administration, Topical; D000368:Aged; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control*; D001810:Blood Volume; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D016903:Drug Monitoring; D006493:Heparin / Q000009:adverse effects* / Q000097:blood; D006801:Humans; D008875:Middle Aged; D008970:Molecular Weight; D011479:Protamines / Q000627:therapeutic use; D007507:Therapeutic Irrigation; D014914:Whole Blood Coagulation Time
chemical_list: D011479:Protamines; D000255:Adenosine Triphosphate; D006493:Heparin