International Perfusion Association

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IPA

Category: Anticoagulation

Protamine 101

Platelet Function Is Preserved After Moderate Cardiopulmonary Bypass Times But Transiently Impaired After Protamine

This study assessed platelet function and numbers in 39 patients undergoing coronary artery bypass surgery with cardiopulmonary bypass (CPB). Platelet function was measured at six different points, including after protamine administration. Results showed no significant impairment of platelet function during CPB. However, platelet function was temporarily reduced after protamine but recovered within 3 hours post-surgery.

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October 4, 2024
Thromboembolic Complications ECMO

Thromboembolic Complications in Continuous Versus Interrupted Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Study

This study investigates thromboembolic complications in patients undergoing venovenous extracorporeal membrane oxygenation (ECMO) with continuous versus interrupted anticoagulation. Data from 346 patients across three ECMO centers were analyzed. Results showed no significant difference in thrombotic complications between the groups, although interruptions in anticoagulation were linked to increased thrombotic events as the frequency and duration of interruptions rose.

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September 28, 2024
Blood Hero

Methodologic Quality and Pharmacotherapy Recommendations for Patient Blood Management Guidelines for Cardiac Surgery on Cardiopulmonary Bypass

This study evaluates the methodological quality and pharmacotherapy recommendations of Patient Blood Management (PBM) guidelines for cardiac surgery involving cardiopulmonary bypass (CPB). Analyzing guidelines using the AGREE II tool, it highlights varying consistency across documents, especially in stakeholder involvement. The study reviews drug therapy strategies including anemia therapy, perioperative antithrombotic administration, intraoperative anticoagulation, and hemostatic drug use, noting a lack of pediatric-specific evidence and the cautious use of certain drugs post-surgery.

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April 21, 2024
Heparin Vs.

Comparison of Bivalirudin Versus Heparin for Anticoagulation During Extracorporeal Membrane Oxygenation

This systematic review and meta-analysis evaluated the efficacy and safety of bivalirudin compared to heparin in patients undergoing extracorporeal membrane oxygenation (ECMO). After reviewing eleven studies focusing on short-term mortality, findings revealed that bivalirudin is associated with significantly lower short-term mortality than heparin, with an odds ratio of 0.71. This suggests bivalirudin may be a preferable anticoagulant for patients on ECMO, though further prospective research is needed to confirm these results.

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March 3, 2024
Heparin

Comparison of Blood Concentration and Weight-Based Heparin and Protamine Dosing Strategies for Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis

This article reviews randomized controlled trials and prospective studies comparing individualized heparin and protamine dosing based on real-time blood heparin concentration versus traditional total body weight methods during cardiopulmonary bypass (CPB). Meta-analysis shows that individualized dosing significantly reduces postoperative blood loss, improves protamine-to-heparin ratios, and increases early postoperative platelet counts. These findings suggest that precision in heparin and protamine dosing could decrease bleeding and transfusion needs, highlighting the potential of machine learning for future advancements in anticoagulation management for CPB.

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February 17, 2024

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