The effect of prostacyclin infusion on platelet hemostatic function in patients undergoing cardiopulmonary bypass

Prostacyclin (PGI2) infusion was studied in patients during cardiopulmonary bypass for coronary artery bypass grafting to assess its capacity to protect platelet hemostatic function. Twelve patients received PGI2 at doses ranging from 20 to 70 ng/kg/min by continuous infusion directly into the bubble oxygenator. Nine control patients were also studied. Platelet counts were not different in the two groups; the platelet count at the completion of the operation was decreased by a mean of 29% in treated patients and 40% in control patients (p greater than 0.15). Bleeding times were uniformly greater than 30 minutes following 30 minutes on bypass in both groups (p greater than 0.5). Also there was no difference in the bleeding times between the treated and untreated groups in the immediate postbypass period (p greater than 0.05). In addition, no difference in transfusion requirements was observed between the treated and control groups. However, plasma levels of platelet factor 4 were lower in the treated patients (p less than 0.05), and, more significantly, blood pressure was lower at all time points in the treated patients (p less than 0.001) despite the greater use of vasopressors. We conclude that PGI2 infusion in this study was of no hemostatic benefit but produced significant hypotension, a potential source of morbidity.