Małopłytkowość indukowana protaminą — nowy problem czy inny typ małopłytkowości poheparynowej?

Abstract

Protamine is widely used to neutralize the anticoagulant effects of unfractionated heparin, particularly after cardiac surgery. Recent reports suggest that some patients undergoing cardiopulmonary bypass exposed to heparin and protamine may develop thrombocytopenia. Multimolecular protamine-heparin complexes lead to immunization and production of immunoglobulin G class antibodies that may activate platelets through FcγIIa receptors. Some patients injected with protamine during cardiopulmonary bypass have increased the risk of early thromboembolic events due to the presence of these antibodies in the blood. In the present review, we will focus on studies investigating the mechanism of platelet activation by anti-protamine-heparin antibodies. We will compare antibodies that are associated with immune heparin-induced thrombocytopenia. In addition, we will describe the clinical consequences of protamine-induced thrombocytopenia, risk factors and general guidelines for management of thromboembolic complications in the post-cardiac surgery patients.