Is there a phase of hypercoagulability when aprotinin is usedin cardiac surgery?

Autor: G Kalweit, Hanno Huwer, Peter Feindt, Volkmer I, Seyfert Ut, Emmeran Gams
Rok vydání: 1994
Předmět:
Pulmonary and Respiratory Medicine
medicine.medical_specialty
medicine.medical_treatment
Antithrombin III
Enzyme-Linked Immunosorbent Assay
Fibrin Fibrinogen Degradation Products
Plasminogen Activators
Aprotinin
Thrombin
Double-Blind Method
Pregnancy
Internal medicine
Fibrinolysis
Coagulopathy
medicine
Humans
Prospective Studies
Cardiac Surgical Procedures
Coronary Artery Bypass
Aged
Blood coagulation test
biology
business.industry
Extracorporeal circulation
Plasminogen
General Medicine
Blood Coagulation Disorders
Middle Aged
medicine.disease
Endocrinology
Enzyme inhibitor
Anesthesia
biology.protein
Female
Surgery
Blood Coagulation Tests
Cardiology and Cardiovascular Medicine
business
Plasminogen activator
hormones
hormone substitutes
and hormone antagonists
Peptide Hydrolases
medicine.drug
Zdroj: European Journal of Cardio-Thoracic Surgery. 8:308-314
ISSN: 1010-7940
DOI: 10.1016/s1010-7940(05)80091-0
Popis: To determine a possible phase of hypercoagulability after the use of high-dose aprotinin, a prospective randomized double-blind study was performed. Twenty patients undergoing aortocoronary bypass surgery were investigated, a placebo group P (n = 10) was compared to an aprotinin group A (n = 10). Examining parameters of thrombin activation and fibrinolysis, we found during extracorporeal circulation--under continuous aprotinin infusion--a significant inhibition of thrombin activation and fibrinolysis in the aprotinin group (thrombin-antithrombin-III-complexes: 95 +/- 23 micrograms/l, d-dimers: 448 +/- 60 ng/ml, plasminogen activity: 33 +/- 3%, plasminogen activator inhibitor: 98 +/- 14 U/ml) compared to the placebo group (thrombin-antithrombin-III-complexes: 143 +/- 13 micrograms/l, d-dimers: 2755 +/- 430 ng/ml, plasminogen activity: 125 +/- 15%, plasminogen activator inhibitor: 10 +/- 4 U/ml). In contrast, after stopping the aprotinin infusion--from the end of extracorporeal circulation until the morning of the first postoperative day--strong thrombin activation took place in the aprotinin group (d-dimers increased from 472 +/- 90 to 1607 +/- 140 ng/ml), while in the placebo group a decrease could be registered. At this time, the fibrinolysis was still reduced in the aprotinin group (plasminogen activity: 48 +/- 6% vs 85 +/- 16% in the placebo group). In conclusion, interference with the thrombohemorrhagic balance induces hypercoagulability after the use of high-dose aprotinin, with elevated levels of thrombin-antithrombin-III-complexes, d-dimers, and plasminogen and a decreased level of plasminogen activator inhibitor. In our opinion, it is necessary to prevent this counter-regulation.(ABSTRACT TRUNCATED AT 250 WORDS)
Databáze: OpenAIRE
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