Effects of aprotinin during cardiopulmonary bypass in patients treated with acetylsalicylic acid.
Of 35 acetylsalicylic acid (ASA)-treated patients undergoing coronary artery bypass surgery, 10 received a high dose of aprotinin (mean 5.2 x 10(6) KIU) during cardiopulmonary bypass (CPB); in 15 cases low-dose aprotinin (2 x 10(6) KIU) was added to the CPB priming solution, and 10 patients made up a control group without aprotinin. Median total blood loss was 52% less in aprotinin-treated patients, irrespective of dose, than in the controls. Fibrin-D dimer levels remained low in patients treated with high-dose aprotinin, but increased significantly in the control group. Platelet adhesion and platelet adenosine triphosphate secretion were reduced after CPB in all patients. Whole-blood aggregation after bypass was enhanced in aprotinin-treated patients. Aprotinin inhibited fibrinolysis and seemingly preserved platelet function despite ASA treatment. In view of the possible risks and relatively high cost of aprotinin, use of a high dose seems unnecessary, since a low dose was equally effective in reducing blood loss in ASA-treated patients.
Ivert
T
T
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
Intonti
M
M
Stain-Malmgren
R
R
Dumitrescu
A
A
Blombäck
M
M
D000255:Adenosine Triphosphate / Q000378:metabolism; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000601:surgery; D007611:Aprotinin / Q000008:administration & dosage*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D005260:Female; D005337:Fibrin / Q000032:analysis; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010973:Platelet Adhesiveness / Q000187:drug effects; D010976:Platelet Count / Q000187:drug effects; D011300:Preoperative Care; D012016:Reference Values; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D006490:Hemostatics; D000255:Adenosine Triphosphate; D005337:Fibrin; D007611:Aprotinin; D001241:Aspirin