title: Effect of aprotinin on activated clotting time, whole blood and plasma heparin measurements.
abstract: Twenty cardiac surgical patients requiring cardiopulmonary bypass were enrolled in this study designed to evaluate the effect of aprotinin on activated clotting time (kaolin and celite), whole blood, and laboratory-based plasma (anti-Xa) heparin measurements. Whole blood heparin measurements were not different (p = 0.98) between aprotinin-treated (3.2 +/- 2.8 U/mL) and control (3.2 +/- 3.0 U/mL) specimens. Plasma anti-Xa heparin measurements were also not different (p = 0.95) between aprotinin-treated (2.7 +/- 2.5 U/mL) and control (2.8 +/- 2.5 U/mL) specimens. The relationship between whole blood (plasma equivalent) and plasma heparin measurements was similar (p = 0.1) in the presence (slope, 1.04; r2 = 0.89) or absence (slope, 1.11; r2 = 0.89) of aprotinin. In contrast to weak correlations between celite (r = 0.50) or kaolin (r = 0.53) activated clotting time values, whole blood heparin measurements correlated well (r = 0.93) with plasma heparin measurements during cardiopulmonary bypass in the presence of aprotinin. These findings indicate that whole blood heparin measurements are unaffected by aprotinin and correlate well with plasma anti-Xa heparin measurements even in the presence of aprotinin. Therefore, the automated protamine titration assay can be used to monitor accurately heparin concentrations in patients receiving aprotinin.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110.
authors.forename: G J
authors.initials: GJ
authors.lastname: Despotis
authors.forename: J H
authors.initials: JH
authors.lastname: Joist
authors.forename: D
authors.initials: D
authors.lastname: Joiner-Maier
authors.forename: A L
authors.initials: AL
authors.lastname: Alsoufiev
authors.forename: A N
authors.initials: AN
authors.lastname: Triantafillou
authors.forename: L T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: S A
authors.initials: SA
authors.lastname: Santoro
authors.forename: D G
authors.initials: DG
authors.lastname: Lappas
mesh_terms: D007611:Aprotinin / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D007692:Diatomaceous Earth / Q000494:pharmacology; D006493:Heparin / Q000097:blood*; D006801:Humans; D007616:Kaolin / Q000494:pharmacology; D010949:Plasma / Q000737:chemistry; D014914:Whole Blood Coagulation Time
chemical_list: D007616:Kaolin; D007692:Diatomaceous Earth; D006493:Heparin; D007611:Aprotinin