'Low-Dose' Aprotinin Modifies Hemostasis but Not Proinflammatory Cytokine Release

Autor: Fracs Kevin G Watterson, Frcs Saeed Ashraf, Ffrca Ranjit Chatrath, Frcs Unnikrishnan Nair, Frcs Nigel R Saunders, Paul G Martin, MCh Yi Tian, Dalia Cowan
Rok vydání: 1997
Předmět:
Zdroj: The Annals of Thoracic Surgery. 63:68-73
ISSN: 0003-4975
DOI: 10.1016/s0003-4975(96)00812-0
Popis: Cytokines are implicated in the pathogenesis of the "whole-body inflammatory response" that may complicate the period after cardiopulmonary bypass (CPB). Low-Dose aprotinin in the pump during CPB has been shown to improve postoperative hemostasis and platelet preservation. We tested the hypothesis that low-dose aprotinin influences the inflammatory reaction (in terms of cytokine release) after CPB.In a prospective, randomized study, 36 patients undergoing elective coronary artery bypass grafting were investigated. Nineteen patients received low-dose aprotinin (2 x 10(6) KIU (280 mg] in the pump), and a control group of 19 did not. Complement activation, cytokine production, leukocyte elastase release. D-dimer level, full blood count, postoperative blood loss, and transfusion requirements were analyzed before, during, and after after CPB.Interleukin-1 beta was not detected in either group, whereas traces of tumor necrosis factor-alpha were infrequently observed. Plasma elastase, interleukin-6, interleukin-8, and neutrophil count increased (p0.001) during and after CPB compared with the baseline levels, reaching a peak at 2 hours after protamine administration in both groups before returning toward baseline at 24 hours. Proinflammatory cytokine markers did not differ significantly (p0.1) between the groups throughout the study period. The C5b-9 level increased (p0.001) in both groups perioperatively, reaching its peak 15 minutes after protamine. Twenty-four-hour postoperative blood loss was significantly (p0.001) reduced in the aprotinin group in association with markedly reduced D-dimer levels (p0.001). Patients in the aprotinin group also received significantly less banked blood postoperatively than the control group (p0.01).Low-dose aprotinin fails to modify proinflammatory cytokine release, yet confers hemostatic improvement through reduced fibrinolysis in patients undergoing routine coronary artery bypass grafting.
Databáze: OpenAIRE
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