title: Differential effects of epsilon-aminocaproic acid and aprotinin on matrix metalloproteinase release in patients following cardiopulmonary bypass.
abstract: This study examined whether differential effects of 2 agents commonly used for hemostatic purposes during cardiac surgery, aprotinin and epsilon-aminocaproic acid (EACA), exist with respect to elevations in proinflammatory interleukins (ILs) and matrix metalloproteinases (MMPs) in patients undergoing coronary artery bypass surgery. Sixty patients were prospectively randomized to receive either aprotinin (1 x 10 KIU; n = 30) or EACA (5 g IV; n = 30), and blood samples were obtained for IL and MMP levels just before induction of anesthesia (Baseline), 10 minutes after separation from cardiopulmonary bypass (Post), and 6 hours after surgery (6 hours). IL-6 was increased at Post in the EACA group and increased further at 6 hours. In the aprotinin group, IL-6 was significantly increased only at 6 hours. MMP subtypes associated with inflammation, MMP-8, and MMP-9 were increased in the EACA group at Post and remained elevated at 6 hours. Thus, differential effects on IL and MMP release occurred between aprotinin and EACA, indicative of different mechanisms of action independent of hemostatic effects.
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Dorman
authors.forename: Robert E
authors.initials: RE
authors.lastname: Stroud
authors.forename: Michael M
authors.initials: MM
authors.lastname: Wyckoff
authors.forename: James L
authors.initials: JL
authors.lastname: Zellner
authors.forename: Don
authors.initials: D
authors.lastname: Botta
authors.forename: Amy H
authors.initials: AH
authors.lastname: Leonardi
authors.forename: John S
authors.initials: JS
authors.lastname: Ikonomidis
authors.forename: Francis G
authors.initials: FG
authors.lastname: Spinale
mesh_terms: D015119:Aminocaproic Acid / Q000008:administration & dosage* / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007611:Aprotinin / Q000008:administration & dosage* / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007378:Interleukins / Q000097:blood; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D020782:Matrix Metalloproteinases / Q000097:blood*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000933:Antifibrinolytic Agents; D007378:Interleukins; D015842:Serine Proteinase Inhibitors; D007611:Aprotinin; D020782:Matrix Metalloproteinases; D015119:Aminocaproic Acid