RETRACTED: Does aprotinin influence endothelial-associated coagulation in cardiac surgery?
Aprotinin has been reported to reduce bleeding in cardiac surgery patients. Its mechanisms of action on coagulation have not been fully elucidated. In a prospectively randomized study of 40 patients undergoing elective aortocoronary bypass grafting, the influence of high-dose aprotinin (2 million IU of aprotinin before CPB, 500,000 IU/h until the end of operation, 2 million IU added to the prime) (N = 20) on endothelial-related coagulation was compared to a nontreated control group (N = 20). Thrombomodulin (TM), protein C and (free) protein S as well as thrombin/antithrombin-III (TAT) plasma concentrations were measured by enzyme-linked immunosorbent assays (ELISA) before the aprotinin infusion, before cardiopulmonary bypass (CPB), during CPB and after CPB, at the end of surgery, 5 hours after CPB, and on the first postoperative day. All standard coagulation parameters (AT-III and fibrinogen plasma levels, platelet count, partial thromboplastin time) did not differ between the two groups. At baseline, TM plasma levels were within the normal range (< 40 ng/mL) and similar in both groups. During CPB, TM plasma concentrations decreased similarly in both groups (aprotinin: 18 +/- 6 ng/mL, control: 17 +/- 7 ng/mL) followed by a comparable increase in the postbypass period until the first postoperative day (aprotinin: 60 +/- 10 ng/mL, control: 53 +/- 11 ng/mL). Protein C and (free) protein S plasma levels also showed no differences between the two groups. On the first postoperative day, baseline values for protein C and protein S had not yet been reached.(ABSTRACT TRUNCATED AT 250 WORDS)
Boldt
J
J
Department of Anesthesiology and Intensive Care Medicine, Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, Giessen, Germany.
Schindler
E
E
Knothe
Ch
C
Hammermann
H
H
Stertmann
W A
WA
Hempelmann
G
G
D000990:Antithrombin III / Q000032:analysis; D007611:Aprotinin / Q000494:pharmacology* / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects* / Q000502:physiology; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004730:Endothelium, Vascular / Q000187:drug effects / Q000502:physiology*; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011446:Prospective Studies; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis; D013917:Thrombin / Q000032:analysis; D018180:Thrombomodulin / Q000032:analysis; D013997:Time Factors
D011486:Protein C; D017293:Protein S; D018180:Thrombomodulin; D000990:Antithrombin III; D005340:Fibrinogen; D007611:Aprotinin; D013917:Thrombin