Aprotinin attenuates platelet accumulation in ischaemia-reperfusion-injured porcine skeletal muscle

This purpose of this study was to evaluate the effect of aprotinin, a serin e protease inhibitor, in ischaemia- and reperfusion-injured myocutaneous fl aps and skin flaps. Flap survival, microcirculatory platelet accumulation, and regional blood flow were investigated in seventeen pigs which had been subjected to 8 h of ischaemia and 18 h of reperfusion. The pigs were random ly assigned to aprotinin treatment (n = 9) or saline (n = 8). In-vitro stud ies were performed to investigate the influence of aprotinin on the activat ed partial thromboplastin time. The survival of skeletal muscle correlated positively with the concentration of aprotinin (P = 0.02) and could not be explained by regional changes in blood flow. Platelet accumulation was decr eased in aprotinin-treated muscle (P = 0.04). In-vitro (n = 10), 100 kallik rein inactivator units/ml aprotinin prolonged the activated partial thrombo plastin time both in plasma (P = 0.001) and in blood (P = 0.002), suggestin g an anticoagulant rather than a procoagulant effect. In conclusion, aproti nin at high concentrations may be beneficial for the survival of skeletal m uscle and provides protection from platelet accumulation in the microcircul ation of skeletal muscle exposed to ischaemia and reperfusion injury. Blood Coag Fibrinol 10:157-165 (C) 1999 Lippincott Williams & Wilkins.