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Effects of protamine and heparin can be detected and easily differentiated by modified thrombelastography (Rotem ® ): an in vitro study

2005; Elsevier BV; Volume: 95; Issue: 3 Linguagem: Inglês

10.1093/bja/aei197

1471-6771

Markus Mittermayr, Josef Margreiter, Corinna Velik‐Salchner, Antón Klingler, Werner Streif, D Friès, Petra Innerhofer,

Sepsis Diagnosis and Treatment

Precise coagulation monitoring might help prevent heparin-protamine mismatch and thus decrease postoperative blood loss. We therefore measured coagulation time (CT) by modified thrombelastography (Rotem) as a possible differential monitor of the effects of heparin and protamine.Undiluted and diluted blood samples from 26 healthy volunteers were spiked with increasing concentrations of heparin (0.1, 0.2, 0.4, 0.8 and 1 U ml(-1)). In addition, undiluted blood was spiked with protamine hydrochloride (0.1, 0.2, 0.4, 0.8 and 1.6 U ml(-1)), and we tested the effect of protamine on the reversal of heparin 0.4 U ml(-1). Heparin-containing samples were analysed using the heparin-sensitive INTEM test and the heparinase-containing HEPTEM test; protamine series were also analysed with the EXTEM test (tissue factor activation).CT by the INTEM test [CT-INTEM; median (min/max)] increased significantly and dose-dependently with increasing concentrations of heparin [control, 175 s (146/226); heparin, 1.0 U ml(-1) 1320 s (559/2100); P<0.001] and protamine [control, 172 s (150/255); protamine, 1.6 U ml(-1) 527 s (300/1345); P 1) from those of protamine excess (CT-INTEM:CT-HEPTEM=1).