L-arginine and S-nitrosoglutathione reduce embolization in humans

L-Arginine reduces platelet aggregation and adhesion in ex vivo studies, but there is no evidence as yet that it has a therapeutic effect on clinical end points. Doppler ultrasound can detect cerebral emboli noninvasively. Such embolic signals are common after carotid endarterectomy, and their frequ...

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Published in:Circulation (New York, N.Y.) N.Y.), 2001-05, Vol.103 (19), p.2371-2375
Main Authors: KAPOSZTA, Zoltan, BASKERVILLE, Paul A, MADGE, David, FRASER, Simon, MARTIN, John F, MARKUS, Hugh S
Format: Article
Language:English
Subjects:
Aged
Arginine - pharmacology
Biological and medical sciences
Carotid Arteries - drug effects
Carotid Arteries - pathology
Carotid Arteries - surgery
Double-Blind Method
Embolism - etiology
Embolism - prevention & control
Endarterectomy, Carotid - adverse effects
Glutathione - analogs & derivatives
Glutathione - pharmacology
Humans
Male
Medical sciences
Middle Aged
Nitroso Compounds - pharmacology
Platelet Aggregation Inhibitors - pharmacology
S-Nitrosoglutathione
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Treatment Outcome
Ultrasonography, Doppler, Transcranial
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Summary:L-Arginine reduces platelet aggregation and adhesion in ex vivo studies, but there is no evidence as yet that it has a therapeutic effect on clinical end points. Doppler ultrasound can detect cerebral emboli noninvasively. Such embolic signals are common after carotid endarterectomy, and their frequency predicts risk of stroke recurrence. We used this situation to determine the antiplatelet efficacy of L-arginine and S-nitrosoglutathione (GSNO), a physiological nitric oxide donor with possible platelet specificity. Patients undergoing carotid endarterectomy were randomized in a double-blind manner between L-arginine (n=14), GSNO (n=14), or placebo (n=14) administered intravenously for 90 minutes, starting 30 minutes after skin closure. All patients were pretreated with aspirin and given heparin during surgery. Transcranial Doppler recordings were made from the ipsilateral middle cerebral artery for 4 hours after surgery, beginning 30 minutes after skin closure, and also at 6 and 24 hours. There were highly significant reductions in the number of Doppler embolic signals in the L-arginine and GSNO groups; first 4 hours, median (range) number of embolic signals, placebo 44.7 (6 to 778), L-arginine 9.5 (0 to 225), and GSNO 0.8 (0 to 8), both P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.103.19.2371