TY - JOUR
T1 - Platelet protection by aprotinin in cardiopulmonary bypass
T2 - Electron microscopic study
AU - Lavee, Jacob
AU - Savion, Naphtali
AU - Smolinsky, Aram
AU - Goor, Daniel A.
AU - Mohr, Rephael
PY - 1992/3
Y1 - 1992/3
N2 - To evaluate the functional integrity of platelets in patients administered the proteinase inhibitor aprotinin during cardiopulmonary bypass, 20 patients undergoing a complicated and prolonged open heart operation were studied. They were randomized to receive either a high dose of aprotinin (total dose, 6 to 7 × 106 KIU) before and during cardiopulmonary bypass (10 patients) or a placebo (10 patients). Blood samples were collected preoperatively, at the termination of bypass, and 90 minutes thereafter to assess platelet count and aggregation on extracellular matrix, which was studied by scanning electron microscopy. On a scale of 1 to 4, mean preoperative platelet aggregation grades were similar in both groups (3.5 ± 0.5). Postoperatively, at the termination of cardiopulmonary bypass and 90 minutes thereafter, all 10 patients treated with aprotinin revealed normal, unchanged platelet aggregation (grade, 3.5 ± 0.5), whereas all placebo-treated patients showed severely disturbed aggregation (grade, 1.4 ± 0.5) (p < 0.001). The platelet count was similar in both groups before and after operation (preoperatively, 182 ± 75 × 109/L and 146 ± 30 × 109/L, and postoperatively, 87 ± 13 × 109/L and 80 ± 27 × 109/L for the aprotinin and placebo groups, respectively). Total 24-hour postoperative bleeding and blood requirement were significantly lower in the aprotinin group (371 ± 84 mL and 2 ± 0.7 units, respectively) compared with the placebo group (608 ± 28 mL and 3.4 ± 1.3 units, respectively) (p < 0.01). These results demonstrate that improved postoperative hemnstatis is directly related to the complete preservation of platelet function achieved by the protective properties of aprotinin.
AB - To evaluate the functional integrity of platelets in patients administered the proteinase inhibitor aprotinin during cardiopulmonary bypass, 20 patients undergoing a complicated and prolonged open heart operation were studied. They were randomized to receive either a high dose of aprotinin (total dose, 6 to 7 × 106 KIU) before and during cardiopulmonary bypass (10 patients) or a placebo (10 patients). Blood samples were collected preoperatively, at the termination of bypass, and 90 minutes thereafter to assess platelet count and aggregation on extracellular matrix, which was studied by scanning electron microscopy. On a scale of 1 to 4, mean preoperative platelet aggregation grades were similar in both groups (3.5 ± 0.5). Postoperatively, at the termination of cardiopulmonary bypass and 90 minutes thereafter, all 10 patients treated with aprotinin revealed normal, unchanged platelet aggregation (grade, 3.5 ± 0.5), whereas all placebo-treated patients showed severely disturbed aggregation (grade, 1.4 ± 0.5) (p < 0.001). The platelet count was similar in both groups before and after operation (preoperatively, 182 ± 75 × 109/L and 146 ± 30 × 109/L, and postoperatively, 87 ± 13 × 109/L and 80 ± 27 × 109/L for the aprotinin and placebo groups, respectively). Total 24-hour postoperative bleeding and blood requirement were significantly lower in the aprotinin group (371 ± 84 mL and 2 ± 0.7 units, respectively) compared with the placebo group (608 ± 28 mL and 3.4 ± 1.3 units, respectively) (p < 0.01). These results demonstrate that improved postoperative hemnstatis is directly related to the complete preservation of platelet function achieved by the protective properties of aprotinin.
UR - http://www.scopus.com/inward/record.url?scp=0026607394&partnerID=8YFLogxK
U2 - 10.1016/0003-4975(92)90272-6
DO - 10.1016/0003-4975(92)90272-6
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AN - SCOPUS:0026607394
SN - 0003-4975
VL - 53
SP - 477
EP - 481
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -