PENTOXIFYLLINE PRELOADING REDUCES ENDOTHELIAL INJURY AND PERMEABILITYIN CARDIOPULMONARY BYPASS

Pentoxifylline (PTX), a methyl xanthine derivative, reduces endothelia l permeability. A double blind, prospective, randomized, placebo contr olled, parallel study was undertaken to assess the effect of PTX on le ukotriene B4, complement fragment C3a, interleukin 6 (IL6), endothelia l injury as measured by von Willebrand factor (vWf), and endothelial p ermeability as measured by urinary albumin excretion (expressed as exc reted urinary albumin to creatinine ratio [ACR]) in patients undergoin g cardiopulmonary bypass (CPB) for elective coronary artery bypass gra fting. Twenty patients were recruited into each treatment arm and give n either PTX 400 mg or placebo three times daily for 1 week before sur gery. Patients were well matched. All operations were performed using one anesthetic, CPB, and a myocardial protection technique. Blood and urine samples were taken after anesthetic induction (baseline); 20 min after the start of CPB; 5 min after removal of the cross clamp; and 5 min and 2, 6, and 24 hr after the end of CPB. Pentoxifylline did not reduce IL6, C3a, and LTB4 release but reduced Factor VIIIRAg and urina ry albumin excretion preoperatively (PTX vs placebo, ACR 1.0 vs 2.1 mg /mmol, vWf 0.8 vs 1.3 IU/ml, p < 0.05) and peak levels (PTX vs placebo , ACR 8.9 vs 16.2, vWf 1.2 vs 2.2, p < 0.05) after CPB. These results suggest that PTX may attenuate the endothelial injury and permeability seen in CPB.