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Effect of recombinant aprotinin on platelet activation in patients undergoing open heart surgery
A C Matzdorff1, D Green, I Cohen
1Northwestern University, Atherosclerosis Program, Chicago, Ill 60611.
The hemostatic effect of recombinant (r)-aprotinin was studied in 41 patients undergoing cardiopulmonary bypass surgery. Flow cytometry was used to measure the expression of glycoprotein 1b (GP1b) and alpha-granule membrane protein 140 (GMP-140) on platelets. Additional parameters studied were beta-thromboglobulin (beta-TG), fibrinogen, fibrinopeptide A, plasminogen, platelet count, and the amount of postoperative chest tube drainage. Chest tube drainage was significantly less in the r-aprotinin-treated patients (p < 0.001). The percentage of platelets expressing GMP-140 increased to 9.7% in r-aprotinin patients and to 12.1% in controls during the surgery. The difference between both groups was not significant. Both values returned to baseline the next day. GP1b expression decreased in both groups by 33-38% during the surgery and returned to baseline the next day. GP1b expression and the plasma concentrations of fibrinogen, fibrinopeptide A, beta-TG, and plasminogen were not different in r-aprotinin and control patients. We conclude that r-aprotinin reduces blood loss during cardiopulmonary bypass surgery, but the primary mechanism is likely not through a protective effect on platelets.
The hemostatic effect of recombinant (r)-aprotinin was studied in 41 patients undergoing cardiopulmonary bypass surgery. Flow cytometry was used to measure the expression of glycoprotein 1b (GP1b) and alpha-granule membrane protein 140 (GMP-140) on platelets. Additional parameters studied were beta-thromboglobulin (beta-TG), fibrinogen, fibrinopeptide A, plasminogen, platelet count, and the amount of postoperative chest tube drainage. Chest tube drainage was significantly less in the r-aprotinin-treated patients (p < 0.001). The percentage of platelets expressing GMP-140 increased to 9.7% in r-aprotinin patients and to 12.1% in controls during the surgery. The difference between both groups was not significant. Both values returned to baseline the next day. GP1b expression decreased in both groups by 33-38% during the surgery and returned to baseline the next day. GP1b expression and the plasma concentrations of fibrinogen, fibrinopeptide A, beta-TG, and plasminogen were not different in r-aprotinin and control patients. We conclude that r-aprotinin reduces blood loss during cardiopulmonary bypass surgery, but the primary mechanism is likely not through a protective effect on platelets.