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Ann Thorac Surg 1994;57:956-959
© 1994 The Society of Thoracic Surgeons

Articles

ATP reduces blood loss produced by hepatin in cardiopulmonary bypass operations

Hermínio V. Garcia, Jr, MD, Ênio Buffalo, MD, Helena B. Nader, DSc, Carl P. Dietrich, MD*

Disciplina de Cirurgia Cardiovascular and Departamento de Bioqufmica, Escola Paulista de Medicina, São Paulo, Brazil

Accepted for publication August 4, 1993.

* Address reprint requests to Dr Dietrich, Departamento de Bioquimica, Escok Paulista de Medians, Rua 3 de Maio 100, N.C. andar, CP 20372, CEP 04044, São Paulo, SP, Brazil.

It was previously shown that topical application of heparin produces enhanced bleeding from small vessels and capillaries. Adenosine triphosphate at low concentrations is able to dislodge heparin bound to a receptor, counteracting its antihemostatic activity. These results led us to measure the amounts of heparin remaining in the blood after protamine neutralization of the patients subjected to cardiopulmonary bypass operation and to test the topical application of the nucleotide. Adenosine triphosphate at a concentration of 10–4 mol/L significantly reduces the blood volume (p < 0.005) oozed from the thoracic cavity of the patients (mean, 288 ± 188 mL) when compared with controls (mean, 564 ± 288 mL). Adenosine triphosphate at 5 x 10–5 mol/L reduces the blood loss to a mean of 370 ± 155 mL in the patients tested (p < 0.08). About 10% of heparin of low molecular weight (≤6.0 Kda), which is also found in the oozed blood, is not neutralized by protamine. We suggest that the excessive blood loss of the patients is probably produced by low molecular weight heparins in the commercial preparations that are not neutralized by protamine.






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