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Endothelial-related coagulation in pediatric surgery
1Department of Anesthesia, Klinikum Ludwigshafen, Germany.
The Annals of Thoracic Surgery
|July 1, 1998
Summary
Aprotinin treatment in children undergoing heart surgery may affect endothelial thrombomodulin levels. This study found lower thrombomodulin concentrations in aprotinin-treated children, suggesting an impact on endothelial function during cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hemostasis and Thrombosis
Background:
- The endothelium is crucial for regulating blood coagulation.
- Imbalances in coagulation pathways can lead to bleeding disorders.
- Aprotinin is used to reduce bleeding, but its mechanism is unclear.
Purpose of the Study:
- To investigate aprotinin's effect on natural coagulation inhibitors in children with congenital heart disease undergoing cardiac surgery.
- To determine if aprotinin influences plasmatic or endothelial-related natural inhibitors.
Main Methods:
- Thirty pediatric patients were randomized into aprotinin-treated or control groups.
- Measurements included thrombomodulin, protein C, protein S, and thrombin/antithrombin complex levels.
- These markers were assessed before, during, and after cardiopulmonary bypass.
Main Results:
- No significant differences were observed in antithrombin III, protein C, protein S, fibrinogen, platelet count, or aPTT between groups.
- Thrombin/antithrombin complex levels increased during bypass similarly in both groups.
- Aprotinin-treated children showed significantly lower thrombomodulin levels during and shortly after bypass.
Conclusions:
- Aprotinin appears to influence endothelial thrombomodulin expression or release.
- The exact mechanism, whether related to anti-inflammatory effects or direct action on thrombomodulin, requires further investigation.