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Excess protamine is known to have anticoagulant effects. All of the following are true concerning the effects of excessive protamine EXCEPT: | Excess protamine is known to have anticoagulant effects. All of the following are true concerning the effects of excessive protamine EXCEPT: | ||
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D. Reduced ADP-induced platelet aggregation | D. Reduced ADP-induced platelet aggregation | ||
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==Answer== | ==Answer== | ||
The answer is C. | The answer is C. | ||
Protamine causes all of the following will cause INCREASED (not decreased) fibrinolysis. Excess protamine will cause an elevation in the ACT, decreased platelet aggregation (specifically reduced ADP-induced aggregation) and increased fibrinolysis. These effects of protamine will alter the clot formation kinetics which will be evident on a TEG analysis. This will result in a decrease in the the alpha angle and maximum amplitude. Studies have suggested that the heparin-protamine complexes may reduce expression of P-selectin and/or reduce calcium utilization by platelets thereby reducing platelet aggregation. Protamine may also directly affect platelet function and inhibit tissue factor induced thrombin generation.<ref>Griffin, Michael J., et al. "The effects of heparin, protamine, and heparin/protamine reversal on platelet function under conditions of arterial shear stress." Anesthesia & Analgesia 93.1 (2001): 20-27.[http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=PPGGFPFEFCDDBMLINCKKNAFBFLNIAA00&Link+Set=S.sh.22.23.27.37%7c5%7csl_10]</ref>. | Protamine causes all of the following will cause INCREASED (not decreased) fibrinolysis. Excess protamine will cause an elevation in the ACT, decreased platelet aggregation (specifically reduced ADP-induced aggregation) and increased fibrinolysis. These effects of protamine will alter the clot formation kinetics which will be evident on a TEG analysis. This will result in a decrease in the the alpha angle and maximum amplitude. Studies have suggested that the heparin-protamine complexes may reduce expression of P-selectin and/or reduce calcium utilization by platelets thereby reducing platelet aggregation. Protamine may also directly affect platelet function and inhibit tissue factor induced thrombin generation.<ref>Griffin, Michael J., et al. "The effects of heparin, protamine, and heparin/protamine reversal on platelet function under conditions of arterial shear stress." Anesthesia & Analgesia 93.1 (2001): 20-27.[http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=PPGGFPFEFCDDBMLINCKKNAFBFLNIAA00&Link+Set=S.sh.22.23.27.37%7c5%7csl_10]</ref>. | ||
==Notes== | ==Notes== | ||
<references /> | <references /> | ||
Shanberge, J. N., et al. "Heparin-protamine complexes in the production of heparin rebound and other complications of extracorporeal bypass procedures." American Journal of Clinical Pathology 87.2 (1987): 210-217. | Shanberge, J. N., et al. "Heparin-protamine complexes in the production of heparin rebound and other complications of extracorporeal bypass procedures." American Journal of Clinical Pathology 87.2 (1987): 210-217. | ||
==Keywords== | ==Keywords== | ||
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