The platelet componentof hemostasis in aortic surgery

Area of Science:

• Cardiovascular Surgery
• Hematology
• Anesthesiology

Background:

• Cardiopulmonary bypass (CPB) significantly impacts platelet count and function during aortic surgery.
• Hypothermic perfusion and circulatory arrest exacerbate platelet dysfunction, leading to increased postoperative bleeding.
• Current aprotinin (Trasylol) dosages may not fully mitigate these adverse effects on hemostasis.

Purpose of the Study:

• To investigate the impact of extracorporeal circulation on platelet hemostasis during aortic surgery.
• To evaluate the efficacy of aprotinin in preserving platelet function under hypothermic conditions.
• To explore the potential benefits of increased aprotinin dosage in reducing postoperative blood loss.

Main Methods:

• Comparative analysis of platelet count and function in patients undergoing aortic surgery with and without CPB.
• Assessment of platelet disorders in patients subjected to hypothermic perfusion or circulatory arrest.
• Evaluation of aprotinin's cytoprotective effects at standard (2 million CIU) and increased (6 million CIU) doses.

Main Results:

• Aortic surgery without CPB showed no significant changes in platelet count or function.
• Hypothermic perfusion or circulatory arrest led to pronounced platelet component disorders, even with 2 million CIU aprotinin.
• Significant postoperative blood loss was observed in patients undergoing hypothermic procedures.

Conclusions:

• Extracorporeal circulation, particularly hypothermic perfusion and circulatory arrest, detrimentally affects platelet hemostasis.
• Standard aprotinin doses are insufficient to prevent platelet dysfunction and excessive bleeding in these conditions.
• Increasing aprotinin dosage to 6 million CIU may offer cytoprotective benefits, preserving platelet quantity and quality.