A PUMP-PRIME APROTININ DOSE IN CARDIAC-SURGERY - APPRAISAL OF ITS EFFECTS ON THE HEMOSTATIC SYSTEM

Objectives: To examine pump-prime aprotinin action on coagulation and fibrinolysis in patients undergoing primary coronary revascularization . Design: A prospective randomized study. Setting: A university hospit al. Participants: Forty-three patients were randomly assigned to eithe r group A, 21 patients treated with 2 x 10(6) kallikrein inhibitor uni ts (KIU) of aprotinin in the cardiopulmonary bypass (CPB) prime, or gr oup B, 22 patients, untreated. Interventions: Patients, scheduled for elective coronary surgery, were treated with 2 x 10(6) KIU Of aprotini n in the CPB prime. Markers of coagulation and fibrinolysis were evalu ated. Measurements and Main Results: Surgical times, number of reopeni ngs, and allogeneic blood requirements were collected for each patient . Blood samples were obtained before and after surgery for assessing c oagulation (prothrombin time [PT], activated partial thromboplastin ti me [aPTT], ethanol test, factor VII, antithrombin III [AT III], thromb in-antithrombin III complex [TAT], fragment 1.2 of prothrombin [F1.2]) and fibrinolysis (fibrin degradation products [FDP], plasmin-antiplas min complexes [PAP], D-dimers) markers variations. In group A surgical times were faster, there were fewer reopenings (0 v 3), and fewer blo od transfusions (1 patient v 4 patients). The two groups did not diffe r for PT, aPTT, and fibrinogen measurements. Postoperative FDP (measur able in more patients of group B at the end of the operation), PAP, an d D-dimers postoperatory levels (less increased in aprotinin group) sh ow the antifibrinolytic properties of the drug. Regarding the coagulat ion markers, factor VII decreased, whereas TAT and F1.2 increased, all to a lesser extent in the aprotinin group compared with the untreated patients, at the end of operation. Conclusion: Pump-prime aprotinin m inimized, even if not completely inhibited, the activation of coagulat ion and fibrinolysis during CPB, possibly ensuring a less complicated and safer postoperative recovery. It seemed to allow the maintenance o f a correct balance of hemostatic systems, avoiding the risk of thromb otic phenomena. Copyright (C) 1997 by W.B. Saunders Company.