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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.
Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].
Show detailsBibliographic details: Wang J, Ma HP, Zheng H. Blood loss after cardiopulmonary bypass, standard vs titrated protamine: a meta-analysis. Netherlands Journal of Medicine 2013; 71(3): 123-127. [PubMed: 23712807]
Abstract
BACKGROUND: The aim of this meta-analysis was to determine whether standard or titrated dosing of protamine is more effective in facilitating haemostasis after cardiac surgery with cardiopulmonary bypass (CPB).
METHODS: We searched MEDLINE, and Biomedical Central using the terms 'cardiopulmonary bypass and heparin and protamine'. Studies were included in the meta-analysis if they were randomised controlled trials (RCTs), controlled clinical studies, or cohort studies with designs comparing the postoperative volume of bleeding between the study group (titrated dose) and the control group (standard dose) for protamine reversal of surgical anticoagulation in CPB procedures. The primary outcome of interest was postoperative blood loss.
RESULTS: There were 219 studies identified in the initial search; four of these were included in the meta-analysis. All studies were RCTs, involving a total of 507 patients. Postoperative blood loss was lower in the study group (range: 625-839 ml) compared with the control group (range: 765-995 ml) in all four studies. Transfusion of packed red blood cells was also lower in the study group compared with the control group in all four studies. There was no evidence of significant heterogeneity in postoperative blood loss among the four studies (Q=4.224, I2=28.98%, p=0.238); hence, a fixed-effects model of analysis was used. The overall/combined standardised difference in means of postoperative blood loss volume significantly favoured study treatment over control treatment (-0.562±0.322, p<0.001).
CONCLUSION: These findings suggest that titrated protamine dosing is more effective than standard protamine dosing for reducing postoperative bleeding after CPB.
- Heparin and protamine titration do not improve haemostasis in cardiac surgical patients.[Can J Anaesth. 1998]Heparin and protamine titration do not improve haemostasis in cardiac surgical patients.Shore-Lesserson L, Reich DL, DePerio M. Can J Anaesth. 1998 Jan; 45(1):10-8.
- Optimal protamine dosing after cardiopulmonary bypass: The PRODOSE adaptive randomised controlled trial.[PLoS Med. 2021]Optimal protamine dosing after cardiopulmonary bypass: The PRODOSE adaptive randomised controlled trial.Miles LF, Burt C, Arrowsmith J, McKie MA, Villar SS, Govender P, Shaylor R, Tan Z, De Silva R, Falter F. PLoS Med. 2021 Jun; 18(6):e1003658. Epub 2021 Jun 7.
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- Review Comparison of Blood Concentration and Weight-Based Heparin and Protamine Dosing Strategies for Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis.[Cureus. 2024]Review Comparison of Blood Concentration and Weight-Based Heparin and Protamine Dosing Strategies for Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis.Raner G, Hu Y, Trowbridge C, Zhang L, Logan J, Wu X, Zhang X. Cureus. 2024 Feb; 16(2):e54144. Epub 2024 Feb 13.
- Review Anticoagulant and side-effects of protamine in cardiac surgery: a narrative review.[Br J Anaesth. 2018]Review Anticoagulant and side-effects of protamine in cardiac surgery: a narrative review.Boer C, Meesters MI, Veerhoek D, Vonk ABA. Br J Anaesth. 2018 May; 120(5):914-927. Epub 2018 Feb 26.
- Blood loss after cardiopulmonary bypass, standard vs titrated protamine: a meta-...Blood loss after cardiopulmonary bypass, standard vs titrated protamine: a meta-analysis - Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews
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