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The Annals of Thoracic Surgery, Vol 41, 193-199, Copyright © 1986 by The Society of Thoracic Surgeons
JK Kirklin, DE Chenoweth, DC Naftel, EH Blackstone, JW Kirklin, DD Bitran, JG Curd, JG Reves and PN Samuelson
Nineteen patients were prospectively selected and studied before and after
the administration of protamine sulfate following cardiopulmonary bypass
(CPB). After protamine administration, C3a, C4a, and C4d were elevated; the
peak levels of C3a and C4a were in samples taken 10 minutes after protamine
administration while those of C4d were in those obtained at 5 hours. Only
C3a was elevated after CPB and before protamine administration. In vitro,
only the combination of protamine sulfate and heparin, and neither alone,
resulted in increased C3a and C4a. Administration of protamine was
associated with small and transient decreases in total white blood cells,
granulocytes, and platelets, and with small and transient reductions in
systemic and pulmonary arterial and left and right atrial pressures.
Systemic vascular resistance fell (p = 0.07), and pulmonary vascular
resistance rose but the change could be due to chance (p = 0.29). These
data and those reported by others support the inference that complement
activation occurs during CPB by the alternative pathway and again during
protamine administration by the classic pathway; and that this accompanies
a whole-body inflammatory reaction with blood cell and hemodynamic changes
which, when extreme, could result in a severe hemodynamic derangement.
ARTICLES
Effects of protamine administration after cardiopulmonary bypass on complement, blood elements, and the hemodynamic state
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A. Bernabei, T. E Maione, M. A. Kowalska, Z. Yan, S. Niewiarowski, and L. H. Edmunds Jr. Reversal of heparin anticoagulation by recombinant platelet factor 4 and protamine sulfate in baboons during cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., April 1, 1995; 109(4): 765 - 771. [Abstract] [Full Text]
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M. Friedman, R. G. Johnson, S. Y. Wang, H. B. Dai, R. L. Thurer, R. M. Weintraub, and F. W. Sellke Pulmonary microvascular responses to protamine and histamineEffects of cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1092 - 1099. [Abstract] [Full Text]
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R. B. Hird, F. G. Spinale, K. W. Hewett, R. Mukherjee, and F. A. Crawford The direct effects of protamine sulfate on myocyte contractile processes J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1100 - 1114. [Abstract] [Full Text]
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R. D. Williams, M. N. D'Ambra, T. E. Maione, K. E. Lynch, and D. F. Keene Recombinant platelet factor 4 reversal of heparin in human cardiopulmonary bypass blood J. Thorac. Cardiovasc. Surg., November 1, 1994; 108(5): 975 - 983. [Abstract] [Full Text]
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 D. S. Kucukaksu, S. F. Katircioglu, G. Saydam, M. Bozdayi, B. Mavitas, O. Tasdemir, and K. Bayazit Beneficial Effects of Prostacyclin on Pulmonary Function During Heparin Reversal with Protamine Vascular and Endovascular Surgery, May 1, 1993; 27(4): 264 - 267. [Abstract] [PDF]
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C. Aren Review article : Heparin and protamine during cardiac surgery Perfusion, July 1, 1989; 4(3): 171 - 181. [PDF]
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A T. Pezzella, A. Ascioti, and P. Ricardi Noncardiogenic pulmonary oedema following cardiopulmonary bypass: report of two cases and review of the literature Perfusion, January 1, 1988; 3(1): 21 - 28. [Abstract] [PDF]
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W. van Oeveren and C. Wildevuur Review article : Blood compatibility of cardiopulmonary bypass circuits Perfusion, October 1, 1987; 2(4): 237 - 244. [PDF]
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