Effects of Prostacyclin on Heparin Reversal with Protamine

Abstract

This study was planned to show the beneficial effects of prostacyclin (PGI 2 ) utilization on adverse effects of protamine. PGI 2 was administered at a rate of 5 ng/kg/min. Twenty patients entered this study. Half of them received PGI 2 whereas the others did not. Right ventricular end-diastolic volume index and right ventricular stroke work index were 72 mL/m 2 and 2.2 g.m/m 2 , respectively, after patients were weaned off the bypass and 79 and 1.5, respectively, at five minutes after pro tamine administration in the control group; these values were 88 and 3.2, re spectively, and 86 and 3, respectively, in the PGI 2 group. Left ventricular stroke work index (g.m/m 2 ) was 27.9 in the control group and 36.7 in the PGI 2 group (p < 0.05) after protamine administration. Thromboxane B 2 levels (pmoL/mL) in coronary sinus (CS) blood were 251 in the control group and 90 in the PGI 2 group at five minutes after protamine administration (p < 0.05). Myocardial blood flow was 174 mL in the control group and 245 mL in the PGI 2 group at five minutes after protamine adminis tration (p < 0.05). Cyclic adenosine monophosphate (cAMP) and cyclic guano- sine monophosphate (cGMP) levels in CS blood were 17 pmoL/mL and 2.1 pmoL/mL, respectively, in the control group and 36 and 0.3, respectively, in the PGI 2 group at five minutes after protamine administration. Leukotriene B 4 level was 129 and 57 pmoL/mL in the control and PGI 2 groups, respectively (at the same time as the cAMP measurement) (p < 0.05). From the results of this study the authors conclude that adverse effects of heparin reversal with protamine can be reduced with the use of PGI 2 .