title: A comparative study of the immune modulating properties of antifibrinolytics in cardiac surgery.
abstract: OBJECTIVE
  Antifibrinolytics, used in cardiac surgery to abate postoperative blood loss, share anti-inflammatory properties by suppression of pro-inflammatory D-dimer and plasmin levels. Additional drug specific immune modulating qualities are often mentioned in the discussion on which antifibrinolytic can best be used. To determine the extent and relevance of these effects, we investigated cytokine and growth factor plasma levels in cardiac surgery patients randomized to receive either tranexamic acid, aprotinin, or placebo. Corticosteroid-treated patients served to put the effects in perspective.
  
  
  METHODS
  Using a biochip immunoassay, plasma of 36 cardiac surgery patients was quantified for 12 cytokines and growth factors, assessed preoperatively and 6, 12, 24, and 48 h after the start of cardiopulmonary bypass. Eight patients were treated with tranexamic acid, nine with aprotinin, and nine received placebo. Ten placebo-treated patients received corticosteroids.
  
  
  RESULTS
  IL-1ß, IL-6, IL-8, IL-10, IFN-γ, TNF-α, VEGF, MCP-1, and EGF plasma concentrations significantly changed over time across all patients. Aprotinin-treated patients showed decreased pro-inflammatory TNF-α and peak MCP-1 plasma levels when compared with placebo. However, corticosteroids attenuated the inflammatory response to a much larger extent, lowering postoperative IL-6, IL-10, IFN-γ, and VEGF concentrations also.
  
  
  CONCLUSIONS
  Aprotinin attenuates postoperative pro-inflammatory levels TNF-α and MCP-1 whereas tranexamic acid does not. The majority of plasma proteins studied, however, were not affected by the use of antifibrinolytics when compared with placebo. A clinically relevant common anti-inflammatory effect through inhibition of fibrinolysis seems therefore unlikely.
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Centre, Albinusdreef 2, Postbus 9600, 2300 RC Leiden, The Netherlands. a.f.l.later@lumc.nl
authors.forename: A F L
authors.initials: AF
authors.lastname: Later
authors.forename: E F
authors.initials: EF
authors.lastname: Bruggemans
authors.forename: F P H T M
authors.initials: FP
authors.lastname: Romijn
authors.forename: J
authors.initials: J
authors.lastname: van Pelt
authors.forename: R J M
authors.initials: RJ
authors.lastname: Klautz
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000494:pharmacology*; D007611:Aprotinin / Q000494:pharmacology; D006348:Cardiac Surgical Procedures; D016207:Cytokines / Q000097:blood; D003710:Demography; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000494:pharmacology*; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood; D008297:Male; D014148:Tranexamic Acid / Q000494:pharmacology
chemical_list: D000933:Antifibrinolytic Agents; D016207:Cytokines; D007155:Immunologic Factors; D036341:Intercellular Signaling Peptides and Proteins; D014148:Tranexamic Acid; D007611:Aprotinin