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

• 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
• Subjects: aprotinin; Aprotinin - administration & dosage; Aprotinin - therapeutic use; Biological and medical sciences; Blood Loss, Surgical; Blood. Blood coagulation. Reticuloendothelial system; cardiopulmonary bypass; Coronary Artery Bypass; Double-Blind Method; Hemodynamics - physiology; Hemostatics - administration & dosage; Hemostatics - therapeutic use; Humans; Inflammation Mediators - blood; Interleukin-6 - blood; Medical sciences; Oxygen - blood; Pharmacology. Drug treatments; Postoperative Period; Prospective Studies; Receptors, Interleukin-1 - antagonists & inhibitors; systemic inflammatory response
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/jcan.2000.18328

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