Late Breaking Original Research
Saturday, November 11, 2023
11:30 AM–01:00 PM
Abstract
Introduction: Cardiac surgery with cardiopulmonary bypass (CPB) imposes major tissue trauma and activates coagulation. To minimize thrombus formation, large doses of unfractionated heparin are given and subsequently reversed with protamine at CPB conclusion. Heparin rebound contributes to post-operative coagulopathy and is the basis for administering additional empiric doses of protamine. However, minimal literature exists to evaluate the safety and efficacy of this practice. Protamine administration in the absence of heparin can also lead to paradoxical anticoagulation and increased microvascular bleeding.
Research Question or Hypothesis: What is the impact of post-operative protamine administration on chest tube output (CTOP) and activated partial thromboplastin time (aPTT)?
Study Design: This was a retrospective, single-center matched cohort study.
Methods: All adult patients who received protamine once within 8 hours of ICU admission after cardiac surgery with CPB from January 1st 2019 to January 1st 2022 were included. Patients with heart/lung transplant, left ventricular device placement surgery, descending or distal aortic procedures, mechanical circulatory support requirement, hemophilia, Von Willibrand disease, lupus anticoagulant and severe thrombocytopenia on baseline (platelet < 100,000/uL) were excluded. Patients were stratified according to pre-treatment aPTT [minimally elevated aPTT (ME, 33 to = 45 seconds), elevated aPTT (EL, > 45 seconds)] and matched 1:1 based on surgery type, age and time from ICU admission to protamine dose.
Results: After matching, 372 patients were included in the final analysis. Most patients underwent elective cardiac surgery with primary sternotomy. Average CTOP decreased within 2 hours of protamine administration by 15 mL/hr in the ME group and by 11 mL/hr in the EL group. Both groups had normalized aPTT within the same time frame. Elevated aPTT prior to protamine administration was not significantly associated with CTOP decrease in multivariable analysis.
Conclusion: There was no association detected between aPTT subgroup and CTOP decrease within 120 minutes.
Presenting Author
Minlang Lin Pharm.DCleveland Clinic
Authors
Kevin Hodges M.D
Cleveland Clinic
Benjamin Hohlfelder PharmD
Cleveland Clinic
Michael Militello PharmD
Cleveland Clinic
Jessica Ward PharmD
Cleveland Clinic