Mechanism of the preserving effect of aprotinin on platelet function and its use in cardiac surgery

Huang, Huiming; Ding, Wenxiang; Su, Zhixun; Zhang, Weizhong

doi:10.1016/s0022-5223(19)33736-5

Cited by 81 publications

(34 citation statements)

References 24 publications

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“…As described in liver transplantation, hyperfibrinolysis contributes to bleeding diathesis seen in cardiac surgery. Aprotinin is commonly used to suppress the hyperfibrinolysis and has been shown to reduce blood loss and improve platelet function (Woodman & Harker, 1990;Huang et al, 1993).…”

Section: Cardiac Surgerymentioning

confidence: 99%

Thrombelastography/thromboelastometry

2005

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The term thrombelastograph (TEG) was used to describe the trace produced from the measurement of the viscoelastic changes associated with fibrin polymerization. Recently the term rotational thromboelastometry has been applied to the output of the ROTEM instrument. Since its first description in 1948, the TEG/ROTEM has been successfully used in the near patient assessment of haemostasis. The greatest use has been the application of TEG-guided transfusion of blood components in hepatic and more widely in cardiac surgery. Recent years have seen a renewed interest in the technology with applications for both pharmaceutical monitoring and patient screening being described. The present review gives a broad overview of the developments and applications related to thrombelastography/thromboelastometry.

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Section: Cardiac Surgerymentioning

confidence: 99%

Thrombelastography/thromboelastometry

2005

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“…19 When plasmin is active during CPB, levels of plasmin inhibitors like α2-antiplasmin, decrease. 19,20 During and after CPB, D-dimer levels, a measurement of the amount of fibrin degraded by plasmin, also increase. In aprotinin-treated patients, because of attenuated fibrinolytic activity, levels of D-dimer were found to be lower compared to controls.…”

Section: Discussionmentioning

confidence: 99%

Effects of Minimal Dose Aprotinin on Blood Loss and Fibrinolytic System-Complement Activation in Coronary Artery Bypass Grafting Surgery

Çiçekçioğlu

Çağlı

Emir³

et al. 2006

J Cardiac Surgery

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“…This fibrinolysis not only inhibits the buildup of clots but also directly damages vital platelet surface receptors leading to impaired platelet function after CPB as well. 4 Additional platelet dysfunction results from the depletion of platelet granules during CPB as a consequence of the actions of thrombin and fibrin split products (FSP). This granule depletion reduces the ability of platelets to aggregate to each other after CPB.…”

mentioning

confidence: 99%

“…[7][8][9] Reductions of the fibrinolytic activity that accompanies CPB in children is also accomplished by aprotinin and is demonstrated by the reductions in levels of FSPs and D-dimers that are seen with its use. 4,7,8,10,11 Finally, children receiving aprotinin experience reduced platelet activation during CPB and improved platelet function after CPB. 4,10,11 Interestingly, while these beneficial hemostatic effects of aprotinin have been documented in children of all ages undergoing primary or repeat sternotomies, the clinical consequences of these effects vary among different subsets of children.…”

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confidence: 99%

The Use of Aprotinin in Pediatric Cardiac Surgery

Miller

2004

Transfus Alt Transfus Med

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SUMMARY The use of aprotinin in children undergoing cardiopulmonary bypass (CPB) attenuates activation of the coagulation and fibrinolytic systems, preserves platelet function, and reduces some inflammatory processes. The clinical outcomes in children as a result of these effects have varied among studies and patient populations, however, this is probably in large part due to variations in dosing regimens. Nevertheless, improved clinical outcomes have been consistently demonstrated in neonates undergoing primary sternotomies and in children undergoing repeat sternotomies or lung transplantation with the use of aprotinin. Such clinical outcomes create a strong argument for the routine administration of aprotinin to these subsets of children. The magnitude of beneficial clinical outcomes after aprotinin administration is dose‐dependent so, while a definitive dosing regimen has not been established for children, higher dose regimens should be employed. Indeed, the use of some very high dose regimens have indicated that aprotinin may even be beneficial in children, other than neonates, undergoing primary sternotomies. The occurrence of adverse effects from the use of aprotinin in children is low but allergic reactions from repeat exposures, especially within six months of the prior use of aprotinin, must be anticipated and guidelines followed to minimize their occurrence and effects. Aprotinin is a potent part of a clinician's arsenal when dealing with children undergoing CPB and its cost‐effective improvement of clinical outcomes justifies its consideration when planning the management strategy of these children.

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Mechanism of the preserving effect of aprotinin on platelet function and its use in cardiac surgery

Cited by 81 publications

References 24 publications

Thrombelastography/thromboelastometry

Thrombelastography/thromboelastometry

Effects of Minimal Dose Aprotinin on Blood Loss and Fibrinolytic System-Complement Activation in Coronary Artery Bypass Grafting Surgery

The Use of Aprotinin in Pediatric Cardiac Surgery

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