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J Thorac Cardiovasc Surg 1997;113:617
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Relation of cyclic guanosine monophosphate and cyclic adenosine monophosphate in reducing the toxic effects of protamine administration

Goya V. Raikar, MD, Hartzell V. Schaff, MD

Section of Cardiovascular Surgery
Mayo Clinic
200 First St. SW
Rochester, MN 55905

Reply to the Editor:

We appreciate the comments of Dr. Katircioglu and his colleagues. As noted in their letter, the adverse effects of protamine may be mediated through a variety of mechanisms, including the complement system. In our study, we measured the serum level of cyclic guanosine monophosphate (cGMP) and found no significant change with the administration of protamine. Therefore we could not conclude that a fall in the cGMP level correlated with the adverse effects of protamine. This investigation focused on inhibition of the nitric oxide pathway, which decreased the systemic hypotension produced by protamine administration.

Attempts to attenuate the adverse effects of protamine have met with variable degrees of success. There may be several effectors of the systemic effects of protamine, and these mechanisms might be expected to cause different clinical manifestations during protamine reversal of heparin.

12/8/78749





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