Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/17235
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dc.contributor.authorKunz, Stephen A-
dc.contributor.authorMiles, Lachlan F-
dc.contributor.authorIanno, Damian J-
dc.contributor.authorMirowska-Allen, Kelly L-
dc.contributor.authorMatalanis, George-
dc.contributor.authorBellomo, Rinaldo-
dc.contributor.authorSeevanayagam, Siven-
dc.date2018-03-15-
dc.date.accessioned2018-03-21T02:16:37Z-
dc.date.available2018-03-21T02:16:37Z-
dc.date.issued2018-09-
dc.identifier.citationPerfusion 2018; 33(6): 445-452en_US
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/17235-
dc.description.abstractAccurate dosing of protamine reversal following on-pump cardiac surgical procedures is challenging, with both excessive and inadequate administration recognised to increase bleeding risk. We aimed to examine the relationship between three ratios for heparin reversal and markers of haemostasis. A retrospective analysis of a prospectively collected database was undertaken at a single tertiary cardiac unit, reviewing all cases of on-pump coronary artery bypass grafts and single valve replacements from 01/01/2011 to 31/12/2015. The ratio between total intra-operative heparin and protamine was stratified to three groups (low: ≤0.6 mg per 100 IU of heparin, moderate: 0.6-1.0 and high: >1.0) and related to the primary outcome of red blood cell (RBC) transfusion, with secondary outcomes being the number of units transfused, the haemoglobin differential and mediastinal drain output at 4 hours. Of the 803 patients identified, 338 received a blood transfusion, with 1035 units being used. Eighteen percent of individuals (145) received a low ratio, 50% (404) received a moderate ratio and 32% (254) a high ratio. Using the moderate group as a reference, the low dose group was 56.5% less likely to have received a RBC transfusion (OR 0.435; 95% CI 0.270:0.703 p=0.001) while the high dose group carried a 241% increased association with transfusion (OR 3.412; 95% CI 2.399:4.853 p<0.001). For those transfused, a lower protamine:heparin ratio was associated with a lower number of units transfused, lesser haemoglobin differential and less mediastinal drain output. Higher doses of intra-operative protamine relative to heparin are associated with greater risk of transfusion and post-operative bleeding.en_US
dc.language.isoeng-
dc.subjectbleedingen_US
dc.subjecthaemostasisen_US
dc.subjectheparinen_US
dc.subjectprotamineen_US
dc.subjectratioen_US
dc.subjectreversalen_US
dc.subjecttransfusionen_US
dc.titleThe effect of protamine dosing variation on bleeding and transfusion after heparinisation for cardiopulmonary bypass.en_US
dc.typeJournal Articleen_US
dc.identifier.journaltitlePerfusionen_US
dc.identifier.affiliationCardiac Surgeryen_US
dc.identifier.affiliationSchool of Medicine, The University of Melbourne, Parkville, Victoria, Australiaen_US
dc.identifier.affiliationAnaesthesiaen_US
dc.identifier.affiliationIntensive Careen_US
dc.identifier.doi10.1177/0267659118763043en_US
dc.type.contentTexten_US
dc.identifier.orcid0000-0001-7424-9472en_US
dc.identifier.orcid0000-0002-1650-8939en_US
dc.identifier.pubmedid29544405-
dc.type.austinJournal Article-
local.name.researcherBellomo, Rinaldo
item.languageiso639-1en-
item.cerifentitytypePublications-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.grantfulltextnone-
item.openairetypeJournal Article-
item.fulltextNo Fulltext-
crisitem.author.deptCardiac Surgery-
crisitem.author.deptAnaesthesia-
crisitem.author.deptAnaesthesia-
crisitem.author.deptCardiac Surgery-
crisitem.author.deptIntensive Care-
crisitem.author.deptData Analytics Research and Evaluation (DARE) Centre-
crisitem.author.deptEndocrinology-
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