Hemostatic mechanism associated with aprotinin during and after the extracorporeal circulation for cardiac and great vessel surgery
Takaori, M.; Fukui, A.; Kimura, K.; Mihira, M.; Endou, S.; Fujiwara, T.
Masui. Japanese Journal of Anesthesiology 44(12): 1661-1666
1995
ISSN/ISBN: 0021-4892 PMID: 8583662 Document Number: 454750
It has been reported that aprotinin (apr) is effective for hemostasis during and after the extracorporeal circulation (ECC) for cardiac or great vessel surgery. However its mechanism remains still obscure. In this study, we observed relationships between changes in interleukin-8 (IL-8), endothelial factors, or D-dimer and aprotinin administered before and after the ECC. Fourteen patients in whom cardiac or great vessel surgery was done using ECC were divided randomly into two groups. Seven subjects in Group I (G-I) were infused 10-6 KIU of apr immediately after anesthesia, immediately before and after the ECC, respectively, and 10-6 KIU of apr were also added during the ECC. Seven other subjects (G-II) were infused 10-6 KIU of apr immediately before and at three hours after the ECC, and also 2 times 10-6 KIU of apr immediately after the ECC. No marked hemorrhagic tendency was noted in all subjects and increase in plasma D-dimer was not marked. Immediately after the ECC, granulocyte elastase in plasma increased markedly in both groups but subsequently decreased in the G-II alone while it remained unchanged in the G-I. Similar changes were observed in plasma IL-8 values. During the ECC, intercellular adhesion molecule-1 in plasma decreased in both groups but von Willebrand factor activity decreased in the G-I alone. From the above data, the hemostatic effect of apr may contribute to protect the dysfunction of endothelial cells or to enhance recovering from the dysfunction during the ECC.