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High-dose aprotinin modulates the balance between proinflammatory and anti-inflammatory responses during coronary artery bypass graft surgery

Objective: To rule out the effect of high-dose aprotinin in respect to the balance of proinflammatory and anti-inflammatory mediators induced by cardiopulmonary bypass (CPB). Design: Randomized, double-blind, placebo-controlled study. Setting: University-affiliated cardiac center. Participants: Twen...

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Published in:Journal of cardiothoracic and vascular anesthesia 2000-12, Vol.14 (6), p.682-686
Main Authors: Tassani, Peter, Augustin, Norbert, Barankay, Andreas, Braun, Siegmund L., Zaccaria, Francesco, Richter, Josef A.
Format: Article
Language:English
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Summary:Objective: To rule out the effect of high-dose aprotinin in respect to the balance of proinflammatory and anti-inflammatory mediators induced by cardiopulmonary bypass (CPB). Design: Randomized, double-blind, placebo-controlled study. Setting: University-affiliated cardiac center. Participants: Twenty patients scheduled for coronary artery bypass graft surgery. Interventions: In group A patients (n = 10), high-dose aprotinin was administered (2 × 106 KIU pre-CPB, 2 × 106 KIU in prime, 500,000 KIU/hr during CPB). In group C patients (n = 10), placebo was used instead. Proinflammatory interleukin (IL)-6, anti-inflammatory IL-1-receptor antagonist, and clinical parameters were measured 8 times perioperatively. The values are presented as mean ± SEM. Measurements and Main Results: Four hours after CPB, IL-6 concentration reached the maximum value, being significantly lower in group A patients as compared with group C patients (615 ± 62 pg/mL v 1409 ± 253 pg/mL; p = 0.019). On the first postoperative day, the concentration of IL-6 in group A patients remained lower (219 ± 24 pg/mL v 526 ± 123 pg/mL; p = 0.015). In contrast, IL-1-receptor antagonist concentration was higher in group A patients as compared with group C patients after CPB (13,857 ± 4264 pg/mL v 5675 ± 1832 pg/mL; p = 0.03). Total postoperative blood loss was lower in group A patients as compared with group C patients (648 ± 64 mL v 1284 ± 183 mL; p = 0.002). Conclusions: High-dose aprotinin treatment reduced the inflammatory reaction and postoperative blood loss. The anti-inflammatory reaction was significantly enhanced in these patients, which suggests that the physiologic reaction of the organism to reduce the deleterious effects from CPB is more pronounced by using high-dose aprotinin. Copyright © 2000 by W.B. Saunders Company
ISSN:1053-0770
1532-8422
DOI:10.1053/jcan.2000.18328