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J Thorac Cardiovasc Surg 2000;120:552-557
© 2000 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology |
From the Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis,a Amsterdam, and the Department of Clinical Chemistry, Leiden University Medical Center,b Leiden, The Netherlands.
Address for reprints: A. Sturk, PhD, Leiden University Medical Center, Department of Clinical Chemistry, PO Box 9600, 2300 RC Leiden, The Netherlands (E-mail: asturk{at}lumc.nl ).
Objectives: Aprotinin is frequently administered systemically to patients undergoing cardiopulmonary bypass to inhibit activation of platelets and plasma protein systems and thus reduce postoperative blood loss. Two reports on local aprotinin administration, that is, into the pericardial cavity, also indicated improvement in postoperative blood loss, but the underlying mechanism was not investigated. We previously reported the disappearance of glycoprotein Ib from the platelet surface and the appearance of platelet-derived microparticles in the pericardial cavity of patients undergoing cardiopulmonary bypass as signs of platelet activation. Here, we investigated whether such local aprotinin administration reduced platelet activation.
Methods: In a double-blind study, 6 patients received aprotinin (500,000 KIU) into the pericardial cavity during the operation and 7 patients received a placebo. Platelet surface glycoprotein Ib expression, concentration of microparticles, and concentration of complexes of platelets with leukocytes, erythrocytes, or each other, were measured by flow cytometry.
Results: We confirmed the reduced glycoprotein Ib expression and the increased concentration of microparticles in the pericardial cavity, as previously reported, and found no increased concentration of platelet complexes. However, no differences between aprotinin and placebo treatments were observed in these platelet activation parameters in the pericardial cavity or the systemic circulation.
Conclusion: We conclude that administration of aprotinin into the pericardial cavity during cardiopulmonary bypass and at concentrations similar to the systemic application does not reduce platelet activation in that compartment or the systemic circulation.
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