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European Journal of Cardio-Thoracic Surgery, Vol 3, 533-537, Copyright © 1989 by European Association for Cardio-thoracic Surgery
CR Wildevuur, L Eijsman, KJ Roozendaal, MP Harder, M Chang and W van Oeveren
A remarkable reduction of postoperative blood loss after cardiopulmonary
bypass (CPB) has been achieved by prophylactic treatment with the
proteinase inhibitor aprotinin. To reveal the mode of action of aprotinin,
23 CPB patients were randomised for aprotinin (2 x 10(6) KIU in the pump
prime) or placebo treatment during CPB. Blood samples were collected before
and during operation. Blood loss and blood requirements were 50% lower in
the aprotinin treated patients than in the untreated patients. The adhesive
capacity of platelets assessed by the amount of platelet membrane
glycoprotein Ib (GP Ib) decreased by 50% in the untreated patients within 5
min of CPB and remained low during CPB, whereas GP Ib did not decrease in
the aprotinin treated patients. Fibrinogen degradation products indicating
plasmin activity could only be measured after 30 min of CPB in the
untreated, but not in the aprotinin treated patients. The kallikrein
inhibiting capacity was 34% decreased in the untreated patients within 5
min of CPB, while it increased by 84% and remained high during CPB in the
aprotinin treated patients. Our results demonstrate that the improved
haemostasis during and after CPB in patients treated with aprotinin can be
attributed to the preserved adhesive capacity of platelets. It remains to
be found whether aprotinin has a primary effect on platelets or a secondary
effect by plasmin or kallikrein inhibition.
ARTICLES
Platelet preservation during cardiopulmonary bypass with aprotinin
Department of Cardiopulmonary Surgery, University Hospital, Groningen, The Netherlands.
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