Cardiopulmonary bypass and the inflammatory response: a role for serine protease inhibitors?
Cardiopulmonary bypass has been shown to activate various inflammatory cascades in the body, resulting in pathophysiological changes that may affect patient outcome after cardiac surgery. Many of these inflammatory cascades are enzyme mediated, involving serine proteases. This report reviews the mechanisms of bypass-mediated activation of the inflammatory cascades and outlines the role of serine protease inhibitors in ameliorating the consequences of the inflammatory response. Experimental data are reviewed on the action of aprotinin in inhibiting the intrinsic coagulation system and in limiting the contact activation of blood platelets and leukocytes. Also reviewed is the role of aprotinin in impacting the incidence of perioperative myocardial ischemia and the central nervous system dysfunction and stroke that are not infrequent complications of surgery with cardiopulmonary bypass.
Murkin
J M
JM
Department of Anaesthesia, University Hospital, London, Ontario, Canada.
D007611:Aprotinin / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D001792:Blood Platelets / Q000187:drug effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002493:Central Nervous System Diseases / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D004789:Enzyme Activation; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000517:prevention & control; D007962:Leukocytes / Q000187:drug effects; D017202:Myocardial Ischemia / Q000517:prevention & control; D012697:Serine Endopeptidases / Q000502:physiology; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*; D018746:Systemic Inflammatory Response Syndrome / Q000201:enzymology / Q000209:etiology* / Q000517:prevention & control
D015842:Serine Proteinase Inhibitors; D007611:Aprotinin; D012697:Serine Endopeptidases