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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 520-527, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AA de Smet, MC Joen, W van Oeveren, KJ Roozendaal, MP Harder, L Eijsman and CR Wildevuur
In this prospective study, the effect of the antiproteinase aprotinin on
anticoagulation during cardiopulmonary bypass was compared with placebo
treatment in a randomized double-blind fashion. The kallikrein- inhibiting
capacity was significantly increased in aprotinin-treated patients and
decreased in the control patients. The intrinsic clotting system was also
inhibited by aprotinin. We demonstrated during cardiopulmonary bypass and
in vitro a significantly prolonged activated clotting time and a remarkable
prolongation of the activated partial thromboplastin time by aprotinin at
low heparin concentrations, whereas the antithrombin III consumption was
significantly reduced. Aprotinin synergistically enhanced the
anticoagulation by heparin, which allowed reduced heparinization. This is
of clinical importance for use in both heparin-resistant and
heparin-sensitive patients undergoing cardiopulmonary bypass and may also
have advantages for routine use during bypass to reduce the adverse effects
of heparin-protamine complexes.
ARTICLES
Increased anticoagulation during cardiopulmonary bypass by aprotinin
Thoraxcentre, University Hospital Groningen, The Netherlands.
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