Investigation of the Effect of Protamine-heparin Dose Ratio Adjustment on Intraoperative Graft Patency and Postoperative Bleeding

Abstract

Objective:The use of systemic anticoagulation and protamine is an indispensable issue for cardiopulmonary bypass. We aimed to investigate the effect of protamine administration in different doses on intraoperative graft opening and postoperative bleeding amounts.Method:Eighty patients scheduled for isolated coronary artery bypass surgery were divided into two equal groups. One group was administered at a ratio of 1:1 (group 1) and the other group (group 2) at doses of 1:0.75 (heparin: protamine). The demographic characteristics of the groups, operative data, and postoperative follow-up parameters were compared. Transit time flow measurement (TTFM) measurements were performed on the grafts used. The amounts of bleeding and transfusion were compared.Results:Demographic characteristics and operative data of both groups were similar. Pulsatility index value was found to be high in TTFM measurements in the saphenous vein used in one patient in group 1 (thrombus in the saphenous vein). In group 2, a high flow was found in the left internal mammary artery in one patient (vasospasm). Although the erythrocyte suspension transfusion amount was partially higher in group 2, it was not statistically significant (p=0.909). The amount of fresh frozen plasma used in group 2 was significantly higher (p=0.001). Also, there was no significant difference in terms of drainage amounts (p=0.968).Conclusion:An unnecessary excess of protamine dose does not have a positive effect on bleeding and transfusion amounts. On the contrary, it may facilitate intraoperative graft occlusion. Studies with larger patient numbers are needed for stronger interpretations.

Keywords

• bleeding
• coronary bypass
• graft patency
• protamine