Heparin Coating With Aprotinin Reduces Blood Activation During Coronary Artery Operations

Heparin Coating With Aprotinin Reduces Blood Activation During Coronary Artery Operations

Background. This study was performed to evaluate whether the combination of heparin-coated extracorporeal circuits (ECC) and aprotinin treatment reduce blood activation during coronary artery operations. Methods. Sixty patients were prospectively divided into two groups (heparin-coated ECC and uncoa...

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Bibliographic Details
Published in:The Annals of thoracic surgery Vol. 63; no. 1; pp. 50 - 56
Main Authors: Baufreton, MD, Christophe, Jansen, MD, PhD, Piet G.M, Le Besnerais, MD, Paul, te Velthuis, PhD, Henk, Thijs, Caroliene M, Wildevuur, MD, PhD, Charles R.H, Loisance, MD, Daniel Y
Format: Journal Article
Language:English
Published: New York, NY Elsevier Inc 1997
Elsevier Science
Subjects:
Aprotinin - therapeutic use
Biological and medical sciences
Blood Loss, Surgical - prevention & control
Blood. Blood coagulation. Reticuloendothelial system
Complement Activation
Coronary Artery Bypass
Extracorporeal Circulation - instrumentation
Female
Fibrin - metabolism
Fibrinolysis
Hemostatics - therapeutic use
Heparin
Humans
Intraoperative Care
Leukocyte Elastase - metabolism
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Postoperative Care
Prospective Studies
Sex Factors
Human
Hemostatic
Treatment efficiency
Coagulation
General anesthesia
Cardiovascular disease
Exploration
Intraoperative
Extracorporeal circuit
Coronary heart disease
Fibrinolysis
Cardiopulmonary bypass
Treatment
Aortocoronary
Bypass
Surgery
Aprotinin
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Summary:Background. This study was performed to evaluate whether the combination of heparin-coated extracorporeal circuits (ECC) and aprotinin treatment reduce blood activation during coronary artery operations. Methods. Sixty patients were prospectively divided into two groups (heparin-coated ECC and uncoated ECC groups), which were comparable in terms of age, sex, left ventricular function, preoperative aspirin use and consequent intraoperative aprotinin use, number of grafts, duration of aortic cross-clamping, and duration of cardiopulmonary bypass. Blood activation was assessed at different times during cardiopulmonary bypass by determination of complement activation (C3 and C4 activation products C3b/c and C4b/c and terminal complement complex), leukocyte activation (elastase), coagulation (scission peptide fibrinopeptide 1+2), and fibrinolysis (D-dimers). Results. Univariate analysis showed that heparin-coated ECC, under conditions of standard heparinization, did not reduce perioperative blood loss and need for transfusion. Heparin coating, however, reduced maximum values of C3b/c (446 ± 212 nmol/L versus 632 ± 264 nmol/L with uncoated ECC; p = 0.0037) and maximum C4b/c values (92 ± 48 nmol/L versus 172 ± 148 nmol/L with uncoated ECC; p = 0.0069). Levels of terminal complement complex, elastase, fibrinopeptide 1+2, and D-dimers were not significantly modified by the use of heparin-coated ECC. Multivariate analysis showed that the intergroup differences in maximum C3b/c and C4b/c values were more pronounced in women in part with high baseline values of C3b/c. We also found that aprotinin contributed to the reduction of maximum values of fibrinopeptide 1+2 and D-dimers, whereas heparin coating had no significant influence on these parameters. Conclusions. We found no evidence of combined properties of heparin-coated ECC and aprotinin in reducing complement activation, coagulation, and fibrinolysis. We therefore recommend use of both together to achieve maximal reduction of blood activation during cardiopulmonary bypass for coronary artery operations. (Ann Thorac Surg 1997;63:50–6)
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ISSN:0003-4975
1552-6259
DOI:10.1016/S0003-4975(96)00964-2