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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 11-18, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
H Huang, W Ding, Z Su and W Zhang
The deficiency of platelet function is the main defect of the hemostatic
mechanism during cardiopulmonary bypass, which greatly exacerbates the
postoperative bleeding complications. In this study, we assessed, from
basic and clinical perspectives, the mechanism of relieving platelet damage
by means of aprotinin. In vitro research confirmed that the addition of
urokinase (40 U/ml) to platelet-rich plasma and the addition of plasmin
(0.3 U/ml) to washed platelets made ristocetin-induced agglutination
decline to 31.6% and 38.5% of control values, respectively. The extent of
decline was positively correlated with the concentration of urokinase and
plasmin. In addition, the platelet membrane glycoprotein Ib decreased to
76.4% of control value. With the addition of urokinase or plasmin to
aprotinin-pretreated platelet-rich plasma or washed platelets, the changes
in agglutination are not statistically significant and the decrement in
glycoprotein Ib is much less marked. Further in vivo research revealed that
cardiopulmonary bypass caused a decrease in plasma alpha 2-antiplasmin,
indicating the fibrinolytic system activation. Meanwhile, ristocetin-
induced agglutination decreased to 39.6% and platelet glycoprotein Ib
decreased to 50% of preoperative values. However, with the administration
of aprotinin, plasma alpha 2-antiplasmin during cardiopulmonary bypass did
not change; platelet agglutination was improved, platelet glycoprotein Ib
was preserved, and this consequently resulted in 46% lower blood loss after
the operation. The results showed that fibrinolysis impaired platelet
function, and this effect may be associated with the hydrolysis of
glycoprotein Ib. Fibrinolytic activation occurred during cardiopulmonary
bypass and contributed to postoperative platelet dysfunction to a great
extent. Aprotinin may inhibit fibrinolysis during cardiopulmonary bypass
and thus relieve the platelet damage and improve the postoperative
hemostatic mechanism.
ARTICLES
Mechanism of the preserving effect of aprotinin on platelet function and its use in cardiac surgery
Department of Pediatric Thoracocardiac Surgery, Xinhua Hospital, Shanghai Second Medical University, China.
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