Document Detail

Influence of ACE inhibition on myocardial damage, the Kallikrein-Kinin system and hemostasis during cardiopulmonary bypass surgery.
MedLine Citation:
PMID:  12077687     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: ACE inhibitors may have a cardioprotective effect by enhancing bradykinin levels during cardiopulmonary bypass (CPB). However, ACE inhibition could lead to unwelcome effects on the kallikrein contact phase during CPB (since reduction of kallikrein activity by aprotinin has been shown to be beneficial) and may alter the hemostasis. We examined the effects of ACE inhibitors on intraoperative myocardial damage, kallikrein contact phase and hemostasis in patients undergoing CPB. METHODS: 47 patients randomly received either 20 mg/d enalapril or placebo. Creatine kinase (CK and CK-MB), lactate dehydrogenase (LDH), troponin T (TnT), thrombin-antithrombin III complex (TAT), fibrinogen and kallikrein-like activity were measured before surgery, during and immediately after CPB, at the end of surgery and 1, 3 and 5 days after surgery. RESULTS: No significant differences between enalapril- and placebo- treated patients concerning CK (318 +/- 38.6 U/l vs. 316 +/- 16.8 U/l), CK-MB, LDH, TnT (1.81 +/- 0.45 ng/ml vs. 1.52 +/- 0.34 ng/ml), TAT, fibrinogen and kallikrein-like-activity could be found during study period. CONCLUSIONS: Reduction of ischemic injury during CPB is not achieved with ACE inhibitors. However, treatment of patients with ACE inhibitors before and during CPB is fully feasible without side effects affecting the kallikrein contact phase or significant influence on hemostasis.
T Walter; U Helber; D Bail; W Heller; H M Hoffmeister
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Thoracic and cardiovascular surgeon     Volume:  50     ISSN:  0171-6425     ISO Abbreviation:  Thorac Cardiovasc Surg     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-06-21     Completed Date:  2002-08-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7903387     Medline TA:  Thorac Cardiovasc Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  150-4     Citation Subset:  IM    
Department of Internal Medicine III, University of Tübingen, Germany.
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MeSH Terms
Administration, Oral
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors / pharmacology,  therapeutic use*
Coronary Artery Bypass*
Coronary Disease / surgery
Double-Blind Method
Enalapril / pharmacology,  therapeutic use*
Fibrinogen / analysis
Heart / drug effects*
Hemostasis / drug effects*
Intraoperative Complications / prevention & control*
Kallikrein-Kinin System / drug effects*
Middle Aged
Myocardial Reperfusion Injury / prevention & control*
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 75847-73-3/Enalapril; 9001-32-5/Fibrinogen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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