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Low doses of aprotinin in aortocoronary bypass surgery--advantages and disadvantages.

R Golański, J Golański, K Chizyński, A Iwaszkiewicz, J Zasłonka, T Pietrucha, S Chrul, C Watała

Med Sci Monit 2000; 6(4): CR722-728 :: ID: 432537


INTRODUCTION: Excessive blood loss, as a result of augmented postoperativedrainage, is considered one of the most serious cardiosurgical complications. The compounding constitutiveanemia seems particularly harmful for patients with coronary artery disease. Aprotinin (Trasylol), anon-specific serine protease inhibitor, is successfully used to reduce excessive postoperative bleedingin such patients. The aim of our study was to verify the hypothesis whether aprotinin used during cardiopulmonarybypass procedure affects hemostatic parameters, which might be crucial for the elevated risk of thromboemboliccomplications. MATERIAL AND METHODS: The group of 54 patients subjected to coronary artery surgical treatmentincluded 30 patients, who were given intraoperatively 3 million KIU aprotinin each, and 24 subjects non-treatedwith aprotinin. Aliquots of blood were withdrawn at several time intervals, until the 5th day after theoperation. Whole blood platelet activation and reactivity (the expressions of P-selectin and glycoproteinIb) were monitored by means of flow cytometry. In addition, several plasma parameters, like PAI-1, t-PA,D-dimers, prothrombin fragment F1 + 2, fibrinogen, ATIII activity, troponin I and CK-MB, as well as plateletcount were determined at each time point. RESULTS: In this study we confirmed the essential advantageof the use of aprotinin: both the postoperative blood drainage and the blood units to be transfused postoperativelyto cardiosurgical patients were vastly reduced in the aprotinin-treated subjects. The enhanced overallfrequency of perioperative myocardial infarction events was not attributed to this group of patients,nor the non Q-wave infarctions were observed more often in patients treated with aprotinin. In thesepatients, fibrinolysis parameters tended to be depressed (with increased PAI-1 dominating over elevatedt-PA) on the first day after the operation, and no significant differences with regard to fibrinogen,prothrombin fragment F1 + 2, troponin I and platelet count. There was a continuous rise in D-dimers inall the postoperative patients, which lasted until the third day and tended to reach plateau at the 5thday after the operation. We failed to reveal the preventive effects of aprotinin on platelet function:both platelet activation and reactivity remained apparently unchanged. Overall, our results rather supportthe reasoning on the advantageous effects of low doses of aprotinin. The use of this inhibitor reducesthe risk of postoperative undesirable bleeding and results in a decreased postoperative drainage andreduced transfused blood units. On the other hand, however, a higher incidence of perioperative Q-waveinfarction in the aprotinin-treated patients, although purely apparent and not statistically significant,might question the unlimited safety of the use of aprotinin in cardiovascular operations.

Keywords: thromboembolism

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750