REWIEW ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 1999 October;40(5):659-66

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

The heparin-protamine interaction. A review

Carr J. A., Silverman N.

From the Division of Cardiac and Thoracic Surgery Henry Ford Hospital, Detroit, MI, USA

The hep­arin-pro­ta­mine inter­ac­tion is a ­topic of ­intense scru­tiny due to its man­da­tory use ­during car­di­o­pul­mo­nary ­bypass. It can be esti­mated ­that ­over 2,000,000 ­patients are ­exposed to the hep­arin-pro­ta­mine inter­ac­tion ­each ­year. ­From clin­ical and experi­mental obser­va­tion it is ­known ­that pro­ta­mine neu­tral­iza­tion of hep­arin ­causes ­increased pul­mo­nary ­artery pres­sures and ­decreased sys­tolic and dia­stolic ­blood pres­sure, myo­car­dial ­oxygen con­sump­tion, car­diac ­output, ­heart ­rate, and ­systemic vas­cular resis­tance. ­These mul­tiple car­di­o­vas­cular ­effects are medi­ated via com­ple­ment acti­va­tion, his­ta­mine ­release, throm­boxane and ­nitric ­oxide pro­duc­tion, and anti­body for­ma­tion. ­This ­article ­reviews the cur­rent under­standing of the hep­arin-pro­ta­mine inter­ac­tion ­from the ­world’s lit­er­a­ture.