Platelet function in cardiac surgery: influence of temperature and aprotinin.
Hypothermic cardiopulmonary bypass (CPB) has been associated with both coagulation defects and hemorrhage. The influence of temperature on platelet function and the benefits of aprotinin in this situation were studied in 60 patients undergoing elective aortocoronary bypass grafting. The patients were randomly divided into four groups (15 patients per group): group 1, normothermic CPB (nasopharyngeal temperature > 34 degrees C); group 2, normothermic bypass and administration of high-dose aprotinin (2 million IU before CPB, 500,000 IU/h until the end of the operation, and 2 million IU added to the prime); group 3, hypothermic CPB (nasopharyngeal temperature < 28 degrees C); and group 4, hypothermic CPB and aprotinin. Platelet function was evaluated by aggregometry (turbidimetric technique), and aggregation was induced by adenosine diphosphate (1 and 2 mumol/L), collagen (4 micrograms/L), and epinephrine (25 mumol/L) before, during, and after CPB into the first postoperative day. Starting from comparable baseline values, maximum platelet aggregation and maximum gradient of platelet aggregation were significantly most reduced after CPB in group 3 (hypothermic CPB without aprotinin) (ranging from -30% to -53% relative to baseline values). In comparison with the other groups, platelet function in this group also recovered less quickly in the later post-bypass period. Hypothermic CPB with aprotinin resulted in less-altered platelet function than hypothermic CPB without aprotinin. Platelet aggregation in aprotinin-treated patients was comparable overall with that in patients undergoing normothermic CPB. On the first postoperative day, aggregation variables had returned to or exceeded baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)
Boldt
J
J
Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University, Giessen, Germany.
Knothe
C
C
Zickmann
B
B
Bill
S
S
Dapper
F
F
Hempelmann
G
G
D007611:Aprotinin / Q000008:administration & dosage* / Q000494:pharmacology; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003094:Collagen / Q000494:pharmacology; D004837:Epinephrine / Q000494:pharmacology; D006400:Hematocrit; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects; D011446:Prospective Studies; D013696:Temperature
D003094:Collagen; D007611:Aprotinin; D004837:Epinephrine