ILOPROST AND ECHISTATIN PROTECT PLATELETS DURING SIMULATED EXTRACORPOREAL-CIRCULATION

Citation
A. Bernabei et al., ILOPROST AND ECHISTATIN PROTECT PLATELETS DURING SIMULATED EXTRACORPOREAL-CIRCULATION, The Annals of thoracic surgery, 59(1), 1995, pp. 149-153
Citations number
31
Categorie Soggetti
Surgery
ISSN journal
00034975
Volume
59
Issue
1
Year of publication
1995
Pages
149 - 153
Database
ISI
SICI code
0003-4975(1995)59:1<149:IAEPPD>2.0.ZU;2-5
Abstract
Temporary, reversible inhibition of platelets during cardiopulmonary b ypass is an attractive strategy to protect platelets and normalize pos toperative bleeding times. Iloprost, an analogue of prostacyclin, and the disintegrins reversibly inhibit platelets by different mechanisms. We tested the hypothesis that reduced doses of iloprost and either ec histatin, a natural disintegrin, or R043-5054, a peptidomimetic, in co mbination provide better platelet protection than any drug alone durin g simulated extracorporeal circulation. Thirty-five recirculation stud ies using fresh, heparinized human blood in an extracorporeal perfusio n circuit that contained a 0.45-m(2) spiral coil membrane oxygenator w ere performed. Iloprost, but neither echistatin nor R043-5054, increas ed platelet cyclic adenosine monophosphate. Combinations of iloprost a nd either fibrinogen receptor platelet cyclic adenosine monophosphate. Platelet adhesion and release of beta-thromboglobulin antigen was com pletely inhibited by combinations of the two classes of drugs, but onl y partially inhibited by each drug alone. Combinations of drugs also c ompletely inhibited platelet aggregation to adenosine diphosphate; the se platelets retained full sensitivity to adenosine diphosphate after 90 minutes of recirculation when drugs were removed by gel filtration. We conclude that combinations of iloprost and a fibrinogen receptor a ntagonist at doses that are unlikely to produce clinical side effects completely inhibit platelet activation and preserve platelet function during in vitro extracorporeal circulation.