Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Germany.
Department of Traumatology and Orthopedic Surgery, Allgemeines Krankenhaus Celle, Celle, Germany.
Asian Cardiovasc Thorac Ann. 2021 Jan;29(1):5-9. doi: 10.1177/0218492320955065. Epub 2020 Aug 27.
Heparin is used for anticoagulation during cardiopulmonary bypass. After weaning from bypass, protamine is administered to neutralize the effects of heparin and thus reestablish hemostasis. Rotational thrombelastometry has been shown to discriminate between heparin and other impairing effects on coagulation. We analyzed the interaction of heparin and protamine under different conditions of overdosage in an in-vitro trial.
Blood samples were taken from 17 healthy volunteers, separated, and spiked in vitro with heparin, protamine for heparin neutralization, an overdosage of protamine, and two dosages of re-heparinization to evaluate heparin effects under the condition of protamine overdosage. All samples were analyzed in a standard ROTEM rotational thromboelastometry device after intrinsic activation with and without addition of heparinase. Coagulation time, maximum clot firmness, and clot formation time were recorded.
Heparin led to prolongation of coagulation and clot formation times in the test without heparinase. Adequate protamine addition normalized the test, and overdosage of protamine led to significant prolongation of both times. Addition of heparin in the presence of protamine overdosage normalized these parameters.
We reconfirmed that the ROTEM device enables discrimination of the effects heparin and protamine on coagulation and detection of the coagulation-impairing effects of protamine overdosage. Furthermore, we were able to show a positive effect on coagulation times by heparin in the presence of protamine overdosage. Because this was an in-vitro study, these findings need to be confirmed in vivo, requiring further research.
心肺转流术期间使用肝素进行抗凝。停用体外循环后，给予鱼精蛋白中和肝素的作用，从而重新止血。旋转血栓弹性描记术已被证明可以区分肝素和对凝血的其他损害作用。我们在体外试验中分析了肝素和鱼精蛋白在不同过量情况下的相互作用。
从 17 名健康志愿者中抽取血样，分离后体外加入肝素、鱼精蛋白中和肝素、鱼精蛋白过量和两次再肝素化，以评估在鱼精蛋白过量的情况下肝素的作用。所有样本均在标准 ROTEM 旋转血栓弹性描记仪中进行分析，分别在加入和不加入肝素酶的情况下进行内在激活。记录凝血时间、最大凝块硬度和凝块形成时间。
在没有肝素酶的测试中，肝素导致凝血和凝块形成时间延长。适当的鱼精蛋白添加使测试正常化，鱼精蛋白过量会导致这两个时间显著延长。在存在鱼精蛋白过量的情况下添加肝素可使这些参数正常化。
我们再次证实 ROTEM 设备能够区分肝素和鱼精蛋白对凝血的影响，并检测鱼精蛋白过量对凝血的损害作用。此外，我们还能够证明在鱼精蛋白过量的情况下肝素对凝血时间有积极影响。由于这是一项体外研究，这些发现需要在体内得到证实，需要进一步研究。
