Aprotinin prevents cardiopulmonary bypass-induced platelet dysfunction. A scanning electron microscope study.

Area of Science:

• Cardiovascular Surgery
• Hematology
• Pharmacology

Background:

• Aprotinin is known to reduce blood loss and improve platelet function during extracorporeal circulation.
• Platelet dysfunction is a concern during cardiopulmonary bypass procedures.

Purpose of the Study:

• To evaluate the protective effect of aprotinin on platelet function during cardiopulmonary bypass.
• To compare the efficacy of high-dose continuous aprotinin versus low-dose bolus aprotinin and placebo.

Main Methods:

• 50 patients undergoing cardiopulmonary bypass were randomized into three groups: high-dose aprotinin, low-dose aprotinin, and placebo.
• Platelet aggregation was assessed using scanning electron microscopy and graded from 1 to 4.
• Blood loss, platelet count, red blood cell units transfused, and homologous blood products were measured postoperatively.

Main Results:

• High-dose aprotinin (Group A) maintained significantly better platelet aggregation (mean grade 3.4) compared to low-dose (Group B, mean grade 2.9) and placebo (Group C, mean grade 1.4).
• Group A experienced significantly less blood loss (395 ml) than Group B (488 ml) and Group C (780 ml).
• Patients receiving aprotinin required fewer red blood cell units and homologous blood products compared to the placebo group.

Conclusions:

• Aprotinin effectively preserves platelet function during cardiopulmonary bypass.
• High-dose aprotinin administration leads to improved postoperative hemostasis and reduced transfusion requirements.
• Aprotinin is beneficial for mitigating platelet dysfunction and associated bleeding complications in cardiac surgery.