Amelioration of the bleeding tendency of preoperative aspirin after aortocoronary bypass grafting
| Autor: | Benjamin P Bidstrup, Ralph N Sapsford, Janet M Bidstrup, Beverley J Hunt, Sajila Sheikh, Rachel N Parratt |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Resuscitation Heart disease Antithrombin III Blood Loss Surgical Coronary Disease Placebo Hemostatics law.invention Aprotinin Double-Blind Method Fibrinolytic Agents law Antifibrinolytic agent Preoperative Care medicine Cardiopulmonary bypass Humans Derivation Coronary Artery Bypass Protein Precursors Aspirin business.industry medicine.disease Antifibrinolytic Agents Peptide Fragments Anesthesia Female Prothrombin Surgery Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | The Annals of Thoracic Surgery. 69:541-547 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/s0003-4975(99)01337-5 |
| Popis: | Aspirin therapy is widely used in the treatment of cardiac disease. It has been recognized as a causative factor for increased bleeding and blood loss after open heart operations.To determine whether high-dose aprotinin maintained its efficacy in reducing blood loss in the presence of aspirin pretreatment in patients undergoing aortocoronary bypass, we performed a double blind study on 60 adult patients. Half received high-dose aprotinin (Trasylol) and half placebo.Total hemoglobin loss, the primary efficacy variable was reduced from 36.1 +/- 31.4 g (mean +/- SD) to 14.1 +/- 16.0 g (p = 0.002). Blood loss was reduced intraoperatively and total loss was reduced from 837.3 mL +/- 404.9 mL to 368.7 mL +/- 164.3 mL (p0.001). The number of patients who did not receive any donor blood products was significantly higher in the aprotinin-treated patients (56.7% versus 23.3%, p = 0.008). Activation of the clotting cascade was significantly less in the treated patients toward the end of cardiopulmonary bypass both by measurement of thrombin-antithrombin III complex (p0.0001) and prothrombin fragment 1 + 2 (p0.0001). D-Dimer generation was significantly less from the onset of bypass and after reversal of heparin in the aprotinin-treated patients (p0.0001).High-dose aprotinin was highly effective in reducing bleeding in this high-risk group of patients. Biochemical analyses suggest the mechanism by which aspirin increases blood loss after cardiopulmonary bypass is different from the blood-preserving effects of aprotinin, which is acting as an antifibrinolytic agent. |
| Databáze: | OpenAIRE |
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