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Ann Thorac Surg 1987;44:640-645
© 1987 The Society of Thoracic Surgeons

Articles

Effects of Aprotinin on Hemostatic Mechanisms during Cardiopulmonary Bypass

Willem van Oeveren, M.Sc., Nicolaas J.G. Jansen, M.D., Ben P. Bidstrup, M.D., Dave Royston, M.D., Steven Westaby, M.D., Heinz Neuhof, MD., Ph.D., Charles R.H. Wildevuur, M.D., Ph.D.*

From the Department of Cardiopulmonary Surgery, University Hospital, Groningen, The Netherlands, The Department of Cardiopulmonary Surgery and Anaesthetics, Hammersmith Hospital, London, England, and the Department of Internal Medicine, University Hospital, Giessen, West Germany

Accepted for publication July 24, 1987.

* Address reprint requests to Dr. Wildevuur, Department of Cardiopulmonary Surgery, Research Division, University Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands

Cardiopulmonary bypass (CPB) is associated with activation of humoral systems, which results in the release of proteases. These proteases may affect platelets and stimulate granulocytes. In the present study, the protease inhibitor aprotinin was given in high doses to 11 patients to achieve plasma concentrations of more than 150 kallikrein inactivator units per milliliter during CPB. At such concentrations, kallikrein and plasmin are effectively inhibited. This treatment resulted in platelet preservation during CPB. Platelet numbers were virtually unaffected, and thromboxane release was prevented in the aprotinin-treated group in contrast to the control group. Postoperatively, hemostasis was significantly better preserved after aprotinin treatment (blood loss of 357 ml in the treated group versus 674 ml in the untreated group; p < 0.01). Since tissue-plasminogen activator activity was similar in both groups, the improved hemostasis most likely should be attributed to platelet preservation. Furthermore, aprotinin lessened neutrophilic elastase release, which might contribute to decreased pulmonary dysfunction in patients at risk.




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 Ann. Thorac. Surg.Home page
S. Westaby
Aprotinin in perspective
Ann. Thorac. Surg., April 1, 1993; 55(4): 1033 - 1041.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
H. Tatar, S. [i. ] [image]i[image]ek, U. Demirkili[image], E. Ozal, H. Suer, O. Ozturk, and H. Isiklar
Topical use of aprotinin in open heart operations
Ann. Thorac. Surg., March 1, 1993; 55(3): 659 - 661.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
J. Butler, G. M. Rocker, and S. Westaby
Inflammatory response to cardiopulmonary bypass
Ann. Thorac. Surg., February 1, 1993; 55(2): 552 - 559.
[Abstract] [PDF]

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 PERSPECT VASC SURG ENDOVASC THERHome page
R. K. Spence
Transfusion Practices in Vascular Surgery
Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1993; 6(2): 14 - 43.
[PDF]

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 Ann. Thorac. Surg.Home page
J. Lavee, Z. Raviv, A. Smolinsky, N. Savion, D. Varon, D. A. Goor, and R. Mohr
Platelet protection by low-dose aprotinin in cardiopulmonary bypass: Electron microscopic study
Ann. Thorac. Surg., January 1, 1993; 55(1): 114 - 119.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
D. M. Cosgrove III, B. Heric, B. W. Lytle, P. C. Taylor, R. Novoa, L. A. R. Golding, R. W. Stewart, P. M. McCarthy, and F. D. Loop
Aprotinin therapy for reoperative myocardial revascularization: A placebo-controlled study
Ann. Thorac. Surg., December 1, 1992; 54(6): 1031 - 1038.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
J. P. A. M. Schonberger, P. A. M. Everts, H. Ercan, J. J. Bredee, J. H. Bavinck, E. Berreklouw, and C. R. M. Wildevuur
Low-dose aprotinin in internal mammary artery bypass operations contributes to important blood saving
Ann. Thorac. Surg., December 1, 1992; 54(6): 1172 - 1176.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
J. Lavee, N. Savion, A. Smolinsky, D. A. Goor, and R. Mohr
Platelet protection by aprotinin in cardiopulmonary bypass: Electron microscopic study
Ann. Thorac. Surg., March 1, 1992; 53(3): 477 - 481.
[Abstract] [PDF]

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 PerfusionHome page
F. B Plotz, W. R Wildevuur, C. R. Wildevuur, R. E Delius, and R. H Bartlett
Platelet consumption during neonatal extracorporeal life support (ECLS)
Perfusion, January 1, 1992; 7(1): 27 - 33.
[Abstract] [PDF]

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 Eur J Cardiothorac SurgHome page
S. Westaby, A. Parry, and R. Pillai
Aortic root replacement: modifications of technique with improvements in technology
Eur J Cardiothorac Surg, January 1, 1992; 6(Supplement_1): S44 - S49.
[Abstract] [PDF]

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T. Efstratiadis, C. Munsch, D. Crossman, and K. Taylor
Aprotinin used in emergency coronary operation after streptokinase treatment
Ann. Thorac. Surg., December 1, 1991; 52(6): 1320 - 1321.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
E. Ovrum, E. A. Holen, M. Abdelnoor, and R. Oystese
Conventional blood conservation techniques in 500 consecutive coronary artery bypass operations
Ann. Thorac. Surg., September 1, 1991; 52(3): 500 - 505.
[Abstract] [PDF]

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W. J. scott, R. Kessler, and J. A. wernly
Blood conservation in cardiac surgery
Ann. Thorac. Surg., November 1, 1990; 50(5): 843 - 851.
[Abstract] [PDF]

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 PerfusionHome page
S. Drakley, A. Fisher, J. O'Riordan, and M. Sharr
The use of cardiopulmonary bypass with profound hypothermia and circulatory arrest during the surgical treatment of giant intracranial aneurysms
Perfusion, July 1, 1990; 5(3): 203 - 208.
[Abstract] [PDF]

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 PerfusionHome page
P. Kesteven
Haemostatic changes during cardiopulmonary bypass
Perfusion, January 1, 1990; 5(1_suppl): 9 - 19.
[PDF]

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 PerfusionHome page
D. Royston
Aprotinin in open-heart surgery: background and results in patients having aortocoronary bypass grafts
Perfusion, January 1, 1990; 5(1_suppl): 63 - 72.
[PDF]

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 PerfusionHome page
M. J Elliott and A. Allen
Aprotinin in paediatric cardiac surgery
Perfusion, January 1, 1990; 5(1_suppl): 73 - 76.
[PDF]

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 Ann. Thorac. Surg.Home page
F. Alajmo, G. Calamai, A. M. Perna, G. Melissano, P. Pretelli, M. F. Palmarini, F. Carbonetto, D. Noferi, V. Boddi, A. Palminiello, et al.
High-Dose Aprotinin: Hemostatic Effects in Open Heart Operations
Ann. Thorac. Surg., October 1, 1989; 48(4): 536 - 539.
[Abstract] [PDF]

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 PerfusionHome page
B. P Bidstrup
Review article : Blood conservation in cardiac surgery: can drugs help?
Perfusion, July 1, 1988; 3(3): 171 - 177.
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