1. Protamine Enhances Fibrinolysis by Decreasing Clot Strength: Role of Tissue Factor- Initiated Thrombin Generation 
Vance G. Nielsen, MD 
The Annals of Thoracic Surgery 
Volume 81, Issue 5, Pages (May 2006)
DOI: /j.athoracsur
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Elastic modulus-based and time-based thromboelastograph variables of clot growth and disintegration. A clot growth-disintegration velocity curve and corresponding thromboelastogram are depicted. (ACL = area of clot lysis [-dynes/cm2]; CDT = clot duration time [CGT+CLT, seconds]; CGT = clot growth time [seconds]; CLT = clot lysis time [seconds]; MRL = maximum rate of lysis [-dynes/cm2/second]; MTG = maximum rate of thrombus generation [dynes/cm2/second]; TMG = time to maximum rate of thrombus generation [seconds]; TML = time to maximum rate of lysis [seconds]; TTG = total thrombus generation [dynes/cm2]).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Representative thromboelastograms and clot growth-disintegration velocity curves of the effects of protamine on fibrinolysis. All plasma samples were exposed to 100 U/mL tissue type plasminogen activator. Data collection occurred over a 30 minute period. (A) and (B) are the thromboelastogram and velocity curve, respectively, of a plasma sample with no protamine added. (C) and (D) are the thromboelastogram and velocity curve of a plasma sample with 25 μg/mL of protamine.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Effects of protamine on factor XIII (FXIII)-deficient and normal plasma after celite or tissue factor activation. Representative thromboelastograms with corresponding clot growth velocity curves are displayed for each condition. (A) Celite activated FXIII-deficient plasma, no protamine. (B) Celite-activated FXIII-deficient plasma, 50 μg/mL of protamine. (C) Celite-activated normal plasma, no protamine. (D) Celite-activated normal plasma, 50 μg/mL of protamine. (E) Tissue factor (0.01%) activated normal plasma, no protamine. (F) Tissue factor (0.01%) activated normal plasma, 50 μg/mL of protamine.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Effects of increasing tissue factor concentration on protamine-mediated enhancement of fibrinolysis. Representative thromboelastograms with corresponding clot growth velocity curves are displayed for each condition. All plasma samples were exposed to 100 U/mL tissue type plasminogen activator. (A) Tissue factor (0.01%) activated normal plasma. (B) Tissue factor (0.01%) activated normal plasma, 25 μg/mL of protamine. (C) Tissue factor (0.1%) activated normal plasma, 25 μg/mL of protamine.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Mechanism by which protamine decreases clot strength and enhances fibrinolysis. Protamine inhibits tissue factor (TF) mediated activation of factor (F) VII, which in turn decreases activation of factor X and prothrombin, and ultimately decreases thrombin generation. Further, protamine inhibits thrombin-mediated fibrinogen polymerization and factor XIII activation, decreasing fibrin polymer formation and cross-linking that subsequently decreases clot strength.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions