title: Immediate effects of individualized heparin and protamine management on hemostatic activation and platelet function in adult patients undergoing cardiac surgery with tranexamic acid antifibrinolytic therapy.
abstract: OBJECTIVE
  This randomized prospective study was initiated to clarify whether individualized heparin and protamine dosing has immediate effects on hemostatic activation and platelet function in adult cardiac surgery.
  
  
  METHODS
  Sixty adults undergoing elective coronary artery bypass grafting (CABG) were assigned to receive individualized heparin and protamine (HMS group, n= 29) or a standard dose (ACT group, n=24). Measures of thrombin generation and Multiplate (Verum Diagnostica, Munich, Germany) platelet function tests were performed before and after cardiopulmonary bypass (CPB).
  
  
  RESULTS
  HMS patients received higher heparin (p = 0.006) and lower protamine (p<0.001) doses. Post-CPB, HMS managed patients showed significantly lower thrombin generation (thrombin-antithrombin (TAT) p<0.02) than the ACT group. Moreover, HMS managed patients had a better preservation of platelet function (COL p = 0.013; ADP p = 0.04; TRAP p = 0.04).
  
  
  CONCLUSIONS
  An individualized and stable heparin concentration and appropriate dosing of protamine can reduce thrombin generation and preserve platelet function, even in short-time CPB.
authors.affiliation: Department of Cardiothoracic Surgery, Martin-Luther-University, Halle, Germany. britt.hofmann@uk-halle.de
authors.forename: B
authors.initials: B
authors.lastname: Hofmann
authors.forename: H
authors.initials: H
authors.lastname: Bushnaq
authors.forename: F B
authors.initials: FB
authors.lastname: Kraus
authors.forename: C
authors.initials: C
authors.lastname: Raspé
authors.forename: A
authors.initials: A
authors.lastname: Simm
authors.forename: R E
authors.initials: RE
authors.lastname: Silber
authors.forename: B
authors.initials: B
authors.lastname: Ludwig-Kraus
mesh_terms: D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D001792:Blood Platelets / Q000166:cytology / Q000187:drug effects; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006494:Heparin Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000187:drug effects; D011446:Prospective Studies; D011479:Protamines / Q000627:therapeutic use*; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D005343:Fibrinolytic Agents; D006494:Heparin Antagonists; D011479:Protamines; D014148:Tranexamic Acid; D006493:Heparin
keywords: cardiac surgery; coagulation; individualized heparin and protamine dosing; platelet function