Effects of Prostacyclin on Heparin Reversal with Protamine

Abstract

This study was planned to show the beneficial effects of prostacyclin (PGI₂) utilization on adverse effects of protamine. PGI₂ was administered at a rate of 5 ng/kg/min. Twenty patients entered this study. Half of them received PGI₂ whereas the others did not.

Right ventricular end-diastolic volume index and right ventricular stroke work index were 72 mL/m² and 2.2 g.m/m², respectively, after patients were weaned off the bypass and 79 and 1.5, respectively, at five minutes after pro tamine administration in the control group; these values were 88 and 3.2, re spectively, and 86 and 3, respectively, in the PGI₂ group. Left ventricular stroke work index (g.m/m²) was 27.9 in the control group and 36.7 in the PGI₂ group (p < 0.05) after protamine administration.

Thromboxane B₂ levels (pmoL/mL) in coronary sinus (CS) blood were 251 in the control group and 90 in the PGI₂ group at five minutes after protamine administration (p < 0.05). Myocardial blood flow was 174 mL in the control group and 245 mL in the PGI₂ group at five minutes after protamine adminis tration (p < 0.05). Cyclic adenosine monophosphate (cAMP) and cyclic guano- sine monophosphate (cGMP) levels in CS blood were 17 pmoL/mL and 2.1 pmoL/mL, respectively, in the control group and 36 and 0.3, respectively, in the PGI₂ group at five minutes after protamine administration. Leukotriene B₄ level was 129 and 57 pmoL/mL in the control and PGI₂ groups, respectively (at the same time as the cAMP measurement) (p < 0.05).

From the results of this study the authors conclude that adverse effects of heparin reversal with protamine can be reduced with the use of PGI₂.

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References

Wakefield TW , Ucros I. , Kresowik TF , et al: Decreased oxygen consumption as a toxic manifestation of protamine sulfate reversal of heparin anticoagulation . J Vasc Surg 9:772-777, 1989.

Kay HR , Afshari M. , Barash P. , et al: Measurement of ejection fraction by thermal dilution techniques . J Surg Res 34:337-346, 1983.

Ganz W. , Tamura K. , Marcus HS , et al: Measurement of coronary sinus blood flow by continuous thermodilution in man. Circulation 44:181-195, 1971.

Marin Neto JA , Syhes MK , Marin Dlb , et al: Effect of heparin and protamine left ventricular performance in the dog. Cardiovasc Res 13:254-259, 1979.

Goldman BS , Joison C. , Austen BG : Cardiovascular effects of protamine sülfate. Ann Thorac Surg 7:459-471, 1969.

Fadali MA , Ledbetter M. , Papacostas CA , et al: Mechanism responsible for the cardiovascular depressant effect of protamine sülfate. Ann Surg 180:232-235, 1974.

Frater Rwm , Oka Y. , Hang Y. , et al: Protamine induced circulatory changes. J Thorac Cardiovasc Surg 87:687-699, 1984.

Horrow JC : Protamine: A review of its toxicity. Anesth Analg 64:348-361, 1985.

Ignarro LJ , Krassikoft N. , Slywka J. : Release of enzymes from a rat liver lysosome fraction: Inhibition by catecholamines and cyclic 3' 5'-adenosinemonophasphate stimulation by cholinergic agents and cyclic 3'-5', quanosine monophosphate. J Pharmacol Exper Ther 186:86-93, 1973.

10.

Sagawa K. , Suga H. , Shoukas AA , et al: End-systolic pressure/volume ratio: A new index of ventricular contractility. Am J Cardiol 40:748-753, 1977.

11.

Lopez-Sendon J. , Coma-Canell L. : Sensitivity and specificity of hemodynamic criteria in the diagnosis of acute right ventricular infarction . Circulation 64:515-525, 1981.

12.

Vincent JL , Thirion M. , Brimoulle S. , et al: Measurement of right ventricular ejection fraction with a modified pulmonary artery catheter. Intensive Care Med 21:33-38, 1986.

13.

Serhan Cna , Radin Jes , Korchak H. , et al: Leukotriene B4 is a complete secretagogue in human neutrophils. Biochem Biophy Res Commun 107:1006-1012, 1986.

14.

Rowe GT , Manson NH , Caplan M. , et al: Hydrogen peroxide and hydroxyl radical mediation of cardiac sarcoplasmic reticulum. Circ Res 53:584-591, 1983.

15.

Hess ML , Eaton NH , Mason NH : Hydrogen peroxide and hydroxyl radical mediation of activated neutrophil induced canine mechanical dysfunction. J Moll Cell Cardiol 18 (suppl):70, 1986.

16.

Simpson PJ , Mitsos SE , Ventura A. , et al: Prostacyclin protects ischemic reperfused myocardium in the dog by inhibition of neutrophil activation. Am Heart J 113:129-137, 1987.

17.

Akerne T. , Price DC , Yee ES , et al: Prevention of ischemia induced myocardial platelet deposition by exogenous prostacylin. J Thorac Cardiovasc Surg 92:99-104, 1986.