Details

Autor(en) / Beteiligte

• Borulu, Ferhat

Titel

Investigation of the Effect of Protamine-heparin Dose Ratio Adjustment on Intraoperative Graft Patency and Postoperative Bleeding/Protamin-heparin Doz Oraninin Degistirilmesinin Intraoperatif Greft Acikligi ve Postoperatif Kanama Uzerine Etkisinin Incelenmesi

Ist Teil von

• Bagcilar Medical Bulletin, 2021-12, Vol.6 (4), p.444

Ort / Verlag

Galenos Yayinevi Tic. Ltd

Erscheinungsjahr

2021

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• 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 Amac: Kardiyopulmoner baypas icin sistemik antikoagulasyon vazgecilmez bir konudur. Bu amacla kullanilan heparin kadar bu etkiyi ortadan kaldiran protamin de cok onemlidir. Ancak az yapilmasi kadar fazla yapilmasi da birtakim yan etkilere neden olabilmektedir. Calismamizda farkli dozlarda yapilan protamin uygulamasinin intraoperatif greft acikligi ve postoperatif kanama miktarlari uzerine etkisinin arastirilmasi amaclanmistir. Yontem: Izole koroner arter baypass cerrahisi yapilmasi planlanan 80 hasta iki esit gruba ayrildi. Bir gruba 1:1 oraninda (grup 1) diger gruba (grup 2) ise 1:0,75 (heparin: protamin) dozlarinda uygulama yapildi. Gruplarin demografik ozellikleri, operatif verileri (baypas suresi, klemp suresi, sicaklik, aktif pihtilasma zamani degerleri vb.), postoperatif takip parametreleri karsilastirildi. Hastalara kullanilan greftlerde transit time flow measurement (TTFM) olcumleri yapildi. Kanama miktarlari ve transfuzyon miktarlari kaydedildi ve karsilastirildi. Bulgular: Gruplar arasinda demografik ozellikler acisindan farklilik gorulmedi. Operatif veriler (kardiyopulmoner bypass suresi, klemp suresi, sicaklik vb.) acisindan her iki grubun verileri benzer nitelikteydi. Grup 1'de bir hastada kullanilan safen vendeki TTFM olcumlerinde pulsatilite indeksi degeri yuksek bulundu (safen vende trombus). Diger grupta da bir hastada sol internal meme arterinde akim yuksek bulundu (vazospazm). Eritrosit suspansiyonu transfuzyon miktarlari grup 2'de kismen fazla olmasina ragmen istatistiksel olarak anlamli degildi (p=0,909). Grup 2'de kullanilan taze donmus plazma miktari anlamli olarak fazla idi (p=0,001). Yine ayni sekilde drenaj miktarlari acisindan anlamli bir farklilik yoktu (p=0,968). Sonuc: Heparin ve protamin kalp cerrahisi icin vazgecilmez iki ilactir. Ancak protamin dozunun gereksiz miktarda fazla yapilmasinin kanama ve transfuzyon miktarlari icin olumlu bir katkisi olmamakla beraber aksine intraoperatif greft tikanikliklari icin kolaylastirici etki yapabilmektedir. Bu konuda daha guclu yorumlar icin daha genis hasta sayilari ile calismalara ihtiyac duyulmaktadir. Anahtar kelimeler: Greft acikligi, kanama, koroner baypas, protamin