Background
Systemic anticoagulation is an indispensable issue for cardiopulmonary bypass. Protamine, which eliminates this effect, is as important as heparin used for this purpose. However, doing too little or too much can cause some side effects. In our study, we aimed to investigate the effect of protamine administration in different doses on intraoperative graft opening and postoperative bleeding amounts.
Material- 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 (bypass time, clamp time, temperature, ACT values, etc.), postoperative follow-up parameters were compared. Transit Time Flow Measurement (TTFM) measurements were performed on the grafts used in the patients. The amount of bleeding and transfusion were recorded and compared.
Results
There was no difference between the groups in terms of demographic characteristics. The data of both groups were similar in terms of operative data (CPB time, clamp time, temperature, etc.). PI (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 the other group, 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
Heparin and protamine are two essential drugs for cardiac surgery. However, 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 on this issue.
Key words: protamin;
bleeding;
graft patency;
transit time flow measurement
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