Gelatin use impairs platelet adhesion during cardiac surgery

Area of Science:

• Biomedical Engineering
• Hematology
• Pharmacology

Background:

• Artificial colloids based on gelatin are utilized as plasma expanders, serving as alternatives to donor blood products.
• Gelatin's impact on hemostasis, particularly platelet function and von Willebrand factor (vWF) interactions, requires thorough investigation.

Purpose of the Study:

• To investigate the effects of gelatin on platelet agglutination, adhesion, and in-vitro platelet plug formation.
• To evaluate the clinical impact of gelatin on hemostasis during cardiac surgery, especially in conjunction with aprotinin.

Main Methods:

• Laboratory experiments assessed gelatin's influence on platelet agglutination induced by ristocetin and polybrene.
• In-vitro platelet plug formation under shear stress, with and without ADP, was analyzed.
• Two clinical studies, a randomized trial during cardiac surgery and a retrospective analysis, examined gelatin's effects on hemostasis.

Main Results:

• Gelatin reduced platelet agglutination velocity and extent with ristocetin and polybrene, and delayed platelet plug formation in the absence of ADP.
• Gelatin did not impede platelet function after vWF release was induced by polybrene or ADP.
• Clinical studies indicated that gelatin can diminish aprotinin's efficacy in cardiac surgery patients and that high doses affect hemostasis.

Conclusions:

• Gelatin primarily affects plasma-von Willebrand factor functionality, partially inhibiting platelet adhesion.
• Gelatin's negative effects on hemostasis are evident in clinical settings, particularly during cardiac surgery with aprotinin.
• The findings suggest a limited role for plasma-vWF and a robust backup mechanism involving platelet-vWF in maintaining hemostasis.