Journal article

Publication year: 2015

Pages: 967-96+

Journal: The Journal of Thoracic and Cardiovascular Surgery

Volume number: 150

Issue number: 4

ISSN: 0022-5223

eISSN: 1097-685X

Open access status: Bronze

DOI Link: https://doi.org/10.1016/j.jtcvs.2015.07.057

Publisher: Elsevier

Abstract: 

Objectives: Platelet-activating antibodies against protamine-heparin-complexes were described in patients undergoing cardiac surgery, but their clinical consequences remain unclear. This prospective single-center observational study aimed to describe the prevalence and clinical consequences of protamine-heparin-complex antibodies in patients undergoing cardiac surgery with cardiopulmonary bypass.

Methods: A total of 200 patients undergoing cardiac surgery with cardiopulmonary bypass were included. Blood samples were collected preoperatively and 1 hour, 24 hours, and 7 days after weaning from cardiopulmonary bypass. All sera were tested for the presence of protamine-heparin-complex antibodies using a modified heparin-induced platelet-activation assay. Specific Fc gamma receptor IIa-dependent platelet activation was confirmed by repeated testing in the presence of the Fcg receptor IIa-blocking antibody IV.3.

Results: Samples from 185 patients were obtained, of whom 24 patients (13%) were positive for protamine-heparin-complex antibodies preoperatively. In all positive samples, functional reactivity was reversible in the presence of IV.3. Although patients with a preoperative presence of protamine-heparin-complex antibodies were significantly older compared with patients negative for protamine-heparin-complex antibodies (73 +/- 9.8 years vs 68 +/- 10 years, P = .037), no other potential risk factors were identified at 1 day before operation. Patients with protamine-heparin-complex antibodies required significantly more protamine to neutralize heparin (47.66 mg vs 41.67 mg, P = .027). Protamine-heparin-complex antibodies have no significant influence on perioperative platelet numbers, bleeding complications, transfusion requirement, thromboembolic events, major cardiovascular and cerebrovascular events, inflammation parameters, or kidney function.

Conclusions: Protamine-heparin-complex antibodies occur frequently in patients undergoing cardiac surgery on cardiopulmonary bypass, resulting in specific platelet activation in vitro. Protamine-heparin-complex antibodies are associated with increased protamine requirement after cardiopulmonary bypass and possibly slower recovery of platelet numbers.

Harvard Citation style: Grieshaber, P., Bakchoul, T., Wilhelm, J., Wagner, A., Wollbrueck, M., Boening, A., et al. (2015) Platelet-activating protamine-heparin-antibodies lead to higher protamine demand in patients undergoing cardiac surgery, The Journal of Thoracic and Cardiovascular Surgery, 150(4), Article 973.e1. pp. 967-96+. https://doi.org/10.1016/j.jtcvs.2015.07.057

APA Citation style: Grieshaber, P., Bakchoul, T., Wilhelm, J., Wagner, A., Wollbrueck, M., Boening, A., & Sachs, U. (2015). Platelet-activating protamine-heparin-antibodies lead to higher protamine demand in patients undergoing cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery. 150(4), Article 973.e1, 967-96+. https://doi.org/10.1016/j.jtcvs.2015.07.057