Heparin coating with aprotinin reduces blood activation during coronary artery operations.
BACKGROUND
This study was performed to evaluate whether the combination of heparin-coated extracorporeal circuits (ECC) and aprotinin treatment reduce blood activation during coronary artery operations.


METHODS
Sixty patients were prospectively divided into two groups (heparin-coated ECC and uncoated ECC groups), which were comparable in terms of age, sex, left ventricular function, preoperative aspirin use and consequent intraoperative aprotinin use, number of grafts, duration of aortic cross-clamping, and duration of cardiopulmonary bypass. Blood activation was assessed at different times during cardiopulmonary bypass by determination of complement activation (C3 and C4 activation products C3b/c and C4b/c and terminal complement complex), leukocyte activation (elastase), coagulation (scission peptide fibrinopeptide 1 + 2), and fibrinolysis (D-dimers).


RESULTS
Univariate analysis showed that heparin-coated ECC, under conditions of standard heparinization, did not reduce perioperative blood loss and need for transfusion. Heparin coating, however, reduced maximum values of C3b/c (446 +/- 212 nmol/L versus 632 +/- 264 nmol/L with uncoated ECC; p = 0.0037) and maximum C4b/c values (92 +/- 48 nmol/L versus 172 +/- 148 nmol/L with uncoated ECC; p = 0.0069). Levels of terminal complement complex, elastase, fibrinopeptide 1 + 2, and D-dimers were not significantly modified by the use of heparin-coated ECC. Multivariate analysis showed that the intergroup differences in maximum C3b/c and C4b/c values were more pronounced in women in part with high baseline values of C3b/c. We also found that aprotinin contributed to the reduction of maximum values of fibrinopeptide 1 + 2 and D-dimers, whereas heparin coating had no significant influence on these parameters.


CONCLUSIONS
We found no evidence of combined properties of heparin-coated ECC and aprotinin in reducing complement activation, coagulation, and fibrinolysis. We therefore recommend use of both together to achieve maximal reduction of blood activation during cardiopulmonary bypass for coronary artery operations.
Baufreton
C
C
Department of Thoracic and Cardiovascular Surgery, Hôpital Henri Mondor, Créteil, France.
Jansen
P G
PG
Le Besnerais
P
P
te Velthuis
H
H
Thijs
C M
CM
Wildevuur
C R
CR
Loisance
D Y
DY
D007611:Aprotinin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003167:Complement Activation; D001026:Coronary Artery Bypass; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D005260:Female; D005337:Fibrin / Q000378:metabolism; D005342:Fibrinolysis; D006490:Hemostatics / Q000627:therapeutic use*; D006493:Heparin; D006801:Humans; D007430:Intraoperative Care; D019272:Leukocyte Elastase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D012737:Sex Factors
D006490:Hemostatics; D005337:Fibrin; D006493:Heparin; D007611:Aprotinin; D019272:Leukocyte Elastase