Effects of organic nitrate vasodilators on platelet function before and after cardiopulmonary bypass

Various in vitro, ex vivo and in vivo tests have shown that organic nitrates attenuate platelet function. Because organic nitrates are commonly administered to patients undergoing cardiac surgery, the postoperative bleeding tendency observed in these patients might be strengthened by nitrates. Therefore, we compared the acute effects of nitroglycerin (0.5 micrograms kg-1 min-1) and isosorbide dinitrate (0.5 or 2.5 micrograms kg-1 min-1) with those of placebo on platelet function both before and after cardiopulmonary bypass in 40 patients undergoing coronary artery bypass grafting (CABG). Bleeding time, platelet retention on glass beads, i.e. platelet adhesiveness, and thromboelastograph tracings were used as indicators of platelet function. Although nitroglycerin and isosorbide dinitrate induced significant haemodynamic changes, e.g. decreases in arterial and pulmonary arterial pressure, they had no significant effects on the indices of platelet function. We conclude that, when given in haemodynamically effective doses, neither nitroglycerin nor isosorbide dinitrate have any measurable acute effect on platelet function as evaluated with on-site tests in patients undergoing CABG surgery.