Preservation of platelets and their function in prolonged cardiopulmonary bypass using prostacyclin

The effects of prostacyclin (PGI2) with and without heparin were studied in 28 dogs that underwent 2 hours of cardiopulmonary bypass. Five groups were created: group I (six dogs) received heparin, 1.25 mg/kg; group II (six dogs) received low-dose heparin, 0.5 mg/kg, and PGI2, 500 ng/kg/min; group III (six dogs) received low-dose heparin alone; group IV (four dogs) received PGI2, 500--1000 ng/kg/min; and group V (six dogs) received ibuprofen, 12.5 mg/kg, dipyridamole, 1 mg/kg, PGI2, 20 ng/kg/min, and low-dose heparin. Significant clot deposition occurred in the oxygenators in groups III, IV and V. Platelet counts decreased to a mean of 36.8 +/- 5.7% (+/- SEM) of control in group I, which had normal clinical heparin dose for dogs, but to only 74 +/- 7% of control in group II. This improvement was significant (p less than 0.005). Platelet aggregation induced by adenosine diphosphate 60 minutes after CPB showed poor aggregation in group I but almost normal aggregation in group II. Protamine was unnecessary in groups that received PGI2. PGI2 in combination with low-dose heparin provides adequate anticoagulation during cardiopulmonary bypass in dogs, preserves platelet number and function and is associated with minimal postoperative bleeding.