A pump-prime aprotinin dose in cardiac surgery: Appraisal of its effects on the hemostatic system

• Published in: Journal of cardiothoracic and vascular anesthesia 1997-12, Vol.11 (7), p.835-839
• Main Authors: Rossi, Marco, Storti, Sergio, Martinelli, Lorenzo, Varano, Carmelita, Marra, Roberto, Zamparelli, Roberto, Possati, Gianfederio, Schiavello, Rocco
• Format: Article
• Language: English
• Subjects: Adult; Aged; aprotinin; Aprotinin - pharmacology; Biological and medical sciences; bleeding; Blood Coagulation - drug effects; Blood. Blood coagulation. Reticuloendothelial system; Cardiopulmonary Bypass; Female; fibrinolysis; Fibrinolysis - drug effects; Hemostatics - pharmacology; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prospective Studies; transfusion
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1016/S1053-0770(97)90116-6

Objectives: To examine pump-prime aprotinin action on coagulation and fibrinolysis in patients undergoing primary coronary revascularization. Design: A prospective randomized study. Setting: A university hospital. Participants: Forty-three patients were randomly assigned to either group A, 21 patients treated with 2 × 10 6 kallikrein inhibitor units (KIU) of aprotinin in the cardiopulmonary bypass (CPB) prime, or group B, 22 patients, untreated. Interventions: Patients, scheduled for elective coronary surgery, were treated with 2 × 10 6 KIU of aprotinin in the CPB prime. Markers of coagulation and fibrinolysis were evaluated. Measurements and Main Results: Surgical times, number of reopenings, and allogeneic blood requirements were collected for each patient. Blood samples were obtained before and after surgery for assessing coagulation (prothrombin time [PT], activated partial thromboplastin time [aPTT], ethanol test, factor VII, antithrombin III [AT III], thrombinantithrombin III complex [TAT], fragment 1.2 of prothrombin [F1.2]) and fibrinolysis (fibrin degradation products [FDP], plasmin-antiplasmin complexes [PAP], D-dimers) markers variations. In group A surgical times were faster, there were fewer reopenings (0 v 3), and fewer blood transfusions (1 patient v 4 patients). The two groups did not differ for PT, aPTT, and fibrinogen measurements. Postoperative FDP (measurable in more patients of group B at the end of the operation), PAP, and D-dimers postoperatory levels (less increased in aprotinin group) show the antifibrinolytic properties of the drug. Regarding the coagulation markers, factor VII decreased, whereas TAT and F1.2 increased, all to a lesser extent in the aprotinin group compared with the untreated patients, at the end of operation. Conclusion: Pump-prime aprotinin minimized, even if not completely inhibited, the activation of coagulation and fibrinolysis during CPB, possibly ensuring a less complicated and safer postoperative recovery. It seemed to allow the maintenance of a correct balance of hemostatic systems, avoiding the risk of thrombotic phenomena.