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Ann Thorac Surg 1993;55:114-119
© 1993 The Society of Thoracic Surgeons

Articles

Platelet protection by low-dose aprotinin in cardiopulmonary bypass: Electron microscopic study

Jacob Lavee, MDa,b,c, Zvi Raviv, MDa,b,c, Aram Smolinsky, MDa,b,c, Naphtali Savion, PhDa,b,c, David Varon, MDa,b,c, Daniel A. Goor, MD*,a,b,c, Rephael Mohr, MDa,b,c

a Department of Cardiac Surgery, The Maurice and Gabriela Goldschleger Eye Institute, Tel Aviv University, Tel Hashomer, Israel
b The National Hemophilia Center, The Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
c The Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel

Accepted for publication April 27, 1992.

* Address reprint requests to Dr Goor, MD, Department of Cardiac Surgery, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.

To evaluate the effect of low-dose aprotinin during cardiopulmonary bypass on platelet function and clinical hemostasis, 30 patients undergoing various cardiopulmonary bypass procedures employing bubble oxygenators were randomized to receive either low-dose aprotinin (2 x 106 KIU in the cardiopulmonary bypass priming solution, 15 patients [group A]) or placebo (15 patients [group B]). Blood samples were collected before and after cardiopulmonary bypass to assess platelet count and aggregation on extracellular matrix, which was studied by a scanning electron microscope. On a scale of 1 to 4 preoperative mean platelet aggregation grades were similar in both groups (3.8 ± 0.5 and 3.5 ± 0.5 for groups A and B, respectively). Postoperatively, platelet aggregation on extracellular matrix decreased slightly in group A (2.8 ± 1.3; p < 0.01) and significantly in group B (1.3 ± 0.5; p < 0.001). Eleven of the 15 patients in group A remained in aggregation grade 3 or 4 compared with none of the group B patients. Platelet count was similar in both groups preoperatively and postoperatively. Total 24-hour postoperative bleeding and blood requirement were lower in the aprotinin group (487 ± 121 mL and 2.3 ± 1.0 units) than in the placebo group (752 ± 404 mL and 6.8 ± 5.1 units; p < 0.01). These results show that the use of low-dose aprotinin during cardiopulmonary bypass provides improved postoperative hemostasis, which might be related to the protection of the platelet aggregating capacity.




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