Advanced

Desmopressin and continous protamine infusion reduces bleeding after CABG in patients with preoperative FRIC-Fragmin® treatment

Gillquist, C. and Schött, U. LU (1996) In Scandinavian Journal of Thoracic and Cardiovascular Surgery 30(SUPPL. 44). p.65-65
Abstract

OBJECT: Subcutaneously intermittent administration of low molecular weight heparin (LMWH-Fragmin®) - (120IU/kgx2 BW) -in unstable angina has been introduced clinically during the last year, after reports of the FRISC and FRIC studies as an alternative to continous infusion of standard heparin. Fragmin® could possible endanger postoperative haemostasis after CABG due to uncomplete reversal of anti-Xa effects with protamine and an increased rise for heparin-rebound due to its longer half-life. METHODS: Thirty consecutive unstable angina patients undergoing CABG were studied. Sonoclot coagulation analyses (Sienco, USA) and Hemochrone®-ACT, routine coagulation and haematological analyses and anti-Xa analyses were performed pre and... (More)

OBJECT: Subcutaneously intermittent administration of low molecular weight heparin (LMWH-Fragmin®) - (120IU/kgx2 BW) -in unstable angina has been introduced clinically during the last year, after reports of the FRISC and FRIC studies as an alternative to continous infusion of standard heparin. Fragmin® could possible endanger postoperative haemostasis after CABG due to uncomplete reversal of anti-Xa effects with protamine and an increased rise for heparin-rebound due to its longer half-life. METHODS: Thirty consecutive unstable angina patients undergoing CABG were studied. Sonoclot coagulation analyses (Sienco, USA) and Hemochrone®-ACT, routine coagulation and haematological analyses and anti-Xa analyses were performed pre and postoperatively. Patients were randomized into two groups for postoperative haemostasis correction. If bleeding exceeded 100 ml after the first hour in the intensive care unit, one group recieved a continous protamine infusion of 25-50 mg/h up to 6 h postoperatively combined with an iv infusion of Octostim® (desmopressin- acetate 0,3 μg/kg BW) during the first postoperative hour in the intensive care, being repeated on the third (DP-group). A control group recieved intermittent injections of protamine or desmopressin, first at ordination (C-group). RESULTS: Significantly lower (p<0,01) postoperative bleeding was seen in the (DP-group) as compared to the control group, with lower anti-Xa plasma-levels. Sonoclot indicated improved platelet-fibrin function in the DP-group with significanly lower peak-times and higher rate 1. Anti-Xa correlated to rate 1. ACT intermittently failed to detect anti-Xa levels up to 0,6 IU/ml. CONCLUSION: A preset postoperative regime with desmopressin + continous low-dose infusion of protamine better reduced the effects of non-reversed anti-Xa after preoperative LMWH (FRIC regime)/rebound of the standard heparin in use during CBP. ACT does not adequately reflect anti-Xa effects of LMWH.

(Less)
Please use this url to cite or link to this publication:
author
publishing date
type
Contribution to journal
publication status
published
in
Scandinavian Journal of Thoracic and Cardiovascular Surgery
volume
30
issue
SUPPL. 44
pages
1 pages
publisher
Scandinavian University Press
external identifiers
  • scopus:33747673604
ISSN
0036-5580
language
English
LU publication?
no
id
d1a5f09c-7855-4503-ac4f-5599255a03dd
date added to LUP
2017-07-27 10:44:05
date last changed
2017-07-27 10:44:05
@article{d1a5f09c-7855-4503-ac4f-5599255a03dd,
  abstract     = {<p>OBJECT: Subcutaneously intermittent administration of low molecular weight heparin (LMWH-Fragmin®) - (120IU/kgx2 BW) -in unstable angina has been introduced clinically during the last year, after reports of the FRISC and FRIC studies as an alternative to continous infusion of standard heparin. Fragmin® could possible endanger postoperative haemostasis after CABG due to uncomplete reversal of anti-Xa effects with protamine and an increased rise for heparin-rebound due to its longer half-life. METHODS: Thirty consecutive unstable angina patients undergoing CABG were studied. Sonoclot coagulation analyses (Sienco, USA) and Hemochrone®-ACT, routine coagulation and haematological analyses and anti-Xa analyses were performed pre and postoperatively. Patients were randomized into two groups for postoperative haemostasis correction. If bleeding exceeded 100 ml after the first hour in the intensive care unit, one group recieved a continous protamine infusion of 25-50 mg/h up to 6 h postoperatively combined with an iv infusion of Octostim® (desmopressin- acetate 0,3 μg/kg BW) during the first postoperative hour in the intensive care, being repeated on the third (DP-group). A control group recieved intermittent injections of protamine or desmopressin, first at ordination (C-group). RESULTS: Significantly lower (p&lt;0,01) postoperative bleeding was seen in the (DP-group) as compared to the control group, with lower anti-Xa plasma-levels. Sonoclot indicated improved platelet-fibrin function in the DP-group with significanly lower peak-times and higher rate 1. Anti-Xa correlated to rate 1. ACT intermittently failed to detect anti-Xa levels up to 0,6 IU/ml. CONCLUSION: A preset postoperative regime with desmopressin + continous low-dose infusion of protamine better reduced the effects of non-reversed anti-Xa after preoperative LMWH (FRIC regime)/rebound of the standard heparin in use during CBP. ACT does not adequately reflect anti-Xa effects of LMWH.</p>},
  author       = {Gillquist, C. and Schött, U.},
  issn         = {0036-5580},
  language     = {eng},
  number       = {SUPPL. 44},
  pages        = {65--65},
  publisher    = {Scandinavian University Press},
  series       = {Scandinavian Journal of Thoracic and Cardiovascular Surgery},
  title        = {Desmopressin and continous protamine infusion reduces bleeding after CABG in patients with preoperative FRIC-Fragmin® treatment},
  volume       = {30},
  year         = {1996},
}