The effect of prostaglandin E1 in patients undergoing clinical cardiopulmonary bypass.
The effect of prostaglandin E1 (PGE1) on protection of platelets during cardiopulmonary bypass (CPB) was evaluated in 9 patients, who were compared with an identical control group of 10 patients undergoing coronary artery bypass grafting. To evaluate the hemodynamic side-effects, PGE1 (0.05 micrograms/kg/min) was infused prior to CPB, resulting in a 26% drop in mean systemic arterial pressure. With this dose, no inhibition of the adenosine diphosphate-induced aggregation could be measured in the pulmonary artery sample. During CPB, the same infusion dose resulted in a severe drop in systemic arterial pressure below 50 mm Hg in 7 of the 9 patients. In 5 of these patients, volume load and phenylephrine infusion could not compensate for the pressure drop, and PGE1 had to be reduced to 0.02 micrograms/kg/min. Platelet aggregation was reduced significantly in the PGE1-treated group compared with the control group, but not completely inhibited during CPB. However, in the postbypass period no platelet preservation was seen in the PGE1 group. In both groups, platelet number and function were equally low. No differences were measured in blood loss or blood transfusion requirements. Except for hypotension, no side-effects of the PGE1 treatment were seen. It is concluded that the hypotension caused by minimal doses of PGE1 during CPB precluded using higher doses, which might have had a greater effect on platelet inhibition. These hypotensive side-effects should be reduced or eliminated before PGE1 can be expected to have the same protective effect on platelet damage that has been demonstrated in animal experiments.
D000527:Alprostadil; D001792:Blood Platelets / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects; D010976:Platelet Count; D011446:Prospective Studies; D011458:Prostaglandins E / Q000009:adverse effects / Q000627:therapeutic use*; D014666:Vasomotor System / Q000187:drug effects
D011458:Prostaglandins E; D000527:Alprostadil