Platelet function during cardiopulmonary bypass not changed by two different doses of aprotinin.

BACKGROUND AND OBJECTIVE Bleeding is one of the major complications of cardiopulmonary bypass (CBP) during cardiac surgery. A platelet function defect seems to be the main cause of the hemostatic problems associated with CBP. Controversial results have been reported concerning the possible protective mechanism of action of aprotinin on platelets. DESIGN AND METHODS In this study we investigated the effect of two different dosages of aprotinin (high and pump-prime-only dose) on platelet reactivity in vitro and adhesion, activation and aggregation receptors on the platelet surface. RESULTS The results obtained from 53 patients undergoing CBP showed a significantly deficient platelet aggregation in response to agonist in all groups without differences between aprotinin treated or not treated patients. No changes in platelet surface expression of glycoprotein (GP) IIb-IIIa, GPIb, GPIV and P-selectin, were observed during CBP between patients treated with aprotinin or not. INTERPRETATION AND CONCLUSIONS These data suggest that inadequate platelet function induced by CBP is not a defect intrinsic to the platelet. We conclude that the hemostatic effect of aprotinin, regardless of the dose employed, is not mediated by protection of platelet function.

[1]  L. Shore-lesserson,et al.  Platelet Function and Cardiopulmonary Bypass , 2001 .

[2]  P. Gazzaniga,et al.  Is Soluble P-selectin Determination a More Reliable Marker of In Vivo Platelet Activation than CD62P Flow Cytometric Analysis? , 1999, Thrombosis and Haemostasis.

[3]  S. Noble,et al.  Aprotinin , 2012, Drugs.

[4]  A. Schmaier,et al.  Contact system: a vascular biology modulator with anticoagulant, profibrinolytic, antiadhesive, and proinflammatory attributes. , 1997, Blood.

[5]  H. Kojima,et al.  Aprotinin inhibits plasmin-induced platelet activation during cardiopulmonary bypass. , 1997, Circulation.

[6]  M. Ray,et al.  Preoperative platelet dysfunction increases the benefit of aprotinin in cardiopulmonary bypass. , 1997, The Annals of thoracic surgery.

[7]  G. Schmitz,et al.  Aprotinin Has no Effect on Platelet Activation and Adhesion during Cardiopulmonary Bypass , 1996, Thrombosis and Haemostasis.

[8]  T. Shankey,et al.  Aprotinin modulation of platelet activation in patients undergoing cardiopulmonary bypass operations. , 1996, The Annals of thoracic surgery.

[9]  P. Noris,et al.  Platelet composition and function in patients undergoing cardiopulmonary bypass for heart surgery. , 1996, Haematologica.

[10]  J. Fontcuberta,et al.  Aprotinin versus desmopressin for patients undergoing operations with cardiopulmonary bypass. A double-blind placebo-controlled study. , 1995, The Journal of thoracic and cardiovascular surgery.

[11]  W. van Oeveren,et al.  Aprotinin effect on platelet function and clotting during cardiopulmonary bypass. , 1994, European Journal of Cardio-Thoracic Surgery.

[12]  A. Michelson,et al.  Aprotinin reduces cardiopulmonary bypass‐induced blood loss and inhibits fibrinolysis without influencing platelets , 1993, British journal of haematology.

[13]  D. Green,et al.  Effect of recombinant aprotinin on platelet activation in patients undergoing open heart surgery. , 1993, Haemostasis.

[14]  R. Colman,et al.  Aprotinin inhibits the contact, neutrophil, and platelet activation systems during simulated extracorporeal perfusion. , 1993, The Journal of thoracic and cardiovascular surgery.

[15]  B. Pasche,et al.  The platelet function defect of cardiopulmonary bypass. , 1993, Blood.

[16]  G. Hempelmann,et al.  Comparison of two aprotinin dosage regimens in pediatric patients having cardiac operations. Influence on platelet function and blood loss. , 1993, The Journal of thoracic and cardiovascular surgery.

[17]  Z. Su,et al.  Mechanism of the preserving effect of aprotinin on platelet function and its use in cardiac surgery. , 1993, The Journal of thoracic and cardiovascular surgery.

[18]  R. Mohr,et al.  Platelet protection by low-dose aprotinin in cardiopulmonary bypass: electron microscopic study. , 1993, The Annals of thoracic surgery.

[19]  A. Lusky,et al.  Aprotinin Prevents Cardiopulmonary Bypass‐Induced Platelet Dysfunction: A Scanning Electron Microscope Study , 1992, Circulation.

[20]  P. Noris,et al.  Platelet function after in vivo and in vitro treatment with thrombolytic agents. , 1992, The American journal of cardiology.

[21]  R. Mohr,et al.  Platelet protection by aprotinin in cardiopulmonary bypass: electron microscopic study. , 1992, The Annals of thoracic surgery.

[22]  J. Soria,et al.  Hemostasis in Patients Undergoing Extracorporeal Circulation: The Effect of Aprotinin (Trasylol) , 1991, Thrombosis and Haemostasis.

[23]  J. Mathew,et al.  Modulation of platelet surface adhesion receptors during cardiopulmonary bypass. , 1991, Anesthesiology.

[24]  M. Turina,et al.  Low-dose aprotinin for reduction of blood loss after cardiopulmonary bypass , 1991, The Lancet.

[25]  J. E. Doran,et al.  Effects of high-dose aprotinin on blood loss, platelet function, fibrinolysis, complement, and renal function after cardiopulmonary bypass. , 1991, The Journal of thoracic and cardiovascular surgery.

[26]  H. Teufelsbauer,et al.  Effect of intraoperative aprotinin administration on postoperative bleeding in patients undergoing cardiopulmonary bypass operation. , 1991, The Journal of thoracic and cardiovascular surgery.

[27]  W. van Oeveren,et al.  Aprotinin protects platelets against the initial effect of cardiopulmonary bypass. , 1990, The Journal of thoracic and cardiovascular surgery.

[28]  L. Eijsman,et al.  PLATELET PRESERVATION BY APROTININ DURING CARDIOPULMONARY BYPASS , 1988, The Lancet.

[29]  W. van Oeveren,et al.  Effects of aprotinin on hemostatic mechanisms during cardiopulmonary bypass. , 1987, The Annals of thoracic surgery.