Document Detail

Is reduced systemic heparinization justified with heparin-bonded bypass circuits in cardiac surgery?--Experience with and without aprotinin.
MedLine Citation:
PMID:  12877888     Owner:  NLM     Status:  MEDLINE    
The effects of aprotinin combined with heparin-bonded bypass circuits and reduced systemic heparinization on haemostasis and inflammatory reactions were measured in patients with elective CABG operation. Patients were randomized to be operated on either without aprotinin (NOAPRO, n=15) or with aprotinin (APRO, n=15) at a low dose of 2 Mio KIU in the priming volume. Activated clotting time was adjusted to 400 +/- 50 s during cardiopulmonary bypass (CPB). Haemostasis (fibrinopeptide A (FPA), thrombin-antithrombin complex (TAT), D-Dimer, plasmin-antiplasmin (PAP), plasminogen-activator inhibitor (PAI)), inflammatory reaction (lactoferrin, IL-6, sTNF-IIR, SC5b-9) and clinical data were evaluated perioperatively. Perioperative clinical and laboratory data including mediastinal drainage volume, postoperative morbidity and mortality were comparable for patients in both groups. FPA was elevated in the APRO group during CPB (P=0.001), D-Dimer in the NOAPRO group after CPB (P=0.002). No differences were seen for TAT, PAP or PAI between the groups. Lactoferrin was elevated in NOAPRO at the end of CPB (P=0.01) and after heparin reversal with protamine sulphate (P=0.02). No intergroup differences were seen for IL-6, sTNF-IIR or SC5b-9 between the groups. In association with reduced heparinization, pump prime aprotinin retains its antifibrinolytic effect in modified bypass equipment with a heparin surface besides an anti-inflammatory effect in terms of inhibition of leukocyte activation. However, thrombin activation may be increased with aprotinin. We therefore recommend sufficient systemic heparinization despite heparin surface modification of bypass equipment.
Beat Kipfer; Lars Englberger; Erich Gygax; Urs Nydegger; Thierry Carrel
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis     Volume:  29     ISSN:  1473-0502     ISO Abbreviation:  Transfus. Apher. Sci.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-07-24     Completed Date:  2003-12-05     Revised Date:  2006-09-18    
Medline Journal Info:
Nlm Unique ID:  101095653     Medline TA:  Transfus Apher Sci     Country:  England    
Other Details:
Languages:  eng     Pagination:  17-24     Citation Subset:  T    
University Clinic for Cardiovascular Surgery, Inselspital, CH-3010 Bern, Switzerland.
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MeSH Terms
Aprotinin / metabolism*,  pharmacology
Blood Coagulation
Cardiopulmonary Bypass / methods*
Hemostasis / drug effects
Heparin / chemistry,  metabolism*
Lactoferrin / metabolism
Middle Aged
Myocardium / metabolism
Time Factors
Reg. No./Substance:
0/Lactoferrin; 9005-49-6/Heparin; 9087-70-1/Aprotinin

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