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Updated: Jun 5, 2026

Application of Hemostatic Devices in Laparoscopic Hepatectomy
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Published on: April 19, 2022

Hemotherapy in open heart surgery.

B El-Badawi1, W Fateih, G T Roberts

  • 1Staff Immunohematologist, Department of Pathology and Laboratory Medicine (Current address: P.O. Box 1272, Jeddah, Saudi Arabia); Staff Cardiac Surgeon, Department of Surgery (Baylor Heart Team); Staff Hematopathologist, Department of Pathology and Laboratory Medicine; and Chairman, Department of Anaesthesiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Annals of Saudi Medicine
|December 18, 2010
PubMed
Summary

Increasing protamine dose post-cardiopulmonary bypass can reduce blood transfusions. Adjusting protamine to heparin ratio and accepting mild thrombocytopenia are key strategies for open heart surgery patients.

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Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism
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Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism

Published on: January 12, 2019

Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Hematology

Background:

  • Open heart surgery frequently requires cardiopulmonary bypass (CPB).
  • CPB can lead to coagulopathy and increased transfusion needs.
  • Heparin anticoagulation and protamine neutralization are critical during CPB.

Purpose of the Study:

  • To evaluate strategies for reducing blood component usage in patients undergoing open heart surgery with CPB.
  • To determine optimal protamine dosing for heparin neutralization after CPB.
  • To assess the impact of non-blood priming and acceptable thrombocytopenia on transfusion requirements.

Main Methods:

  • Retrospective review of clinical charts and transfusion records of 216 patients.
  • Categorization of patients into five groups based on operative procedures.
  • Analysis of preoperative hemostatic function tests and post-CPB outcomes.

Main Results:

  • Normal preoperative hemostatic function was observed across all groups.
  • Heparin rebound occurred in all groups, suggesting protamine underneutralization.
  • Increased protamine dose (1.5-1.7 mg/mg heparin) and non-blood priming were associated with reduced transfusion needs.
  • Acceptance of mild thrombocytopenia (60-80 x 10(9)/L) also lowered blood component usage.

Conclusions:

  • Optimizing protamine dosage is crucial for effective heparin neutralization and reduced fresh frozen plasma requirements.
  • Non-blood priming and tolerance of mild post-CPB thrombocytopenia can significantly decrease blood product utilization.
  • A preoperative blood ordering schedule is recommended for open heart surgery patients to manage transfusion needs effectively.