Reducing thrombin formation during cardiopulmonary bypass: is there a benefit of the additional anticoagulant action of aprotinin?

Journal of Cardiovascular Pharmacology
W Dietrich

Abstract

During cardiopulmonary bypass (CPB), contact-phase activation of factor XII, prekallikrein, and high molecular weight kininogen initiates the intrinsic pathway of coagulation. To prevent gross clot formation during CPB, heparin is commonly used as an anticoagulant. There is a wide variability in the sensitivity of individual patients to the actions of heparin. We did not find a significant correlation between plasma heparin levels and concentrations of D-dimers, thrombin-antithrombin III complexes (TAT), and prothrombin fragments F1+2 as markers of fibrinolysis and coagulation activation. In addition, heparin cannot completely inhibit thrombin formation and action and may play a central role in the coagulation disorders associated with CPB. F1+2 and TAT rise throughout the course of CPB and fibrin monomers are generated. Attempts to improve anti-coagulation using heparin-coated bypass circuits and specific inhibitors of thrombin have not thus far proven successful. The serine protease inhibitor aprotinin can inhibit contact-phase activation, as evidenced by generation of significantly fewer prothrombin fragments F1+2, thrombin-antithrombin III complexes, fibrinopeptide A, and fibrin monomers in aprotinin-treated patients underg...Continue Reading

References

Dec 1, 1992·The Annals of Thoracic Surgery·D M CosgroveF D Loop
Oct 1, 1991·Journal of Cardiothoracic and Vascular Anesthesia·G MarxV Tilsner
Sep 1, 1991·Anesthesiology·M SalmenperäS Mattila
Oct 1, 1991·American Journal of Hematology·G SoslauI Brodsky
Dec 1, 1987·The Annals of Thoracic Surgery·W van OeverenC R Wildevuur
Oct 1, 1989·The Annals of Thoracic Surgery·F AlajmoA Palminiello
Jan 1, 1987·Seminars in Thrombosis and Hemostasis·C KluftJ J Emeis
May 1, 1985·The American Journal of Physiology·E I Peerschke, J A Wainer
May 29, 1986·The New England Journal of Medicine·L A Harker
Jan 1, 1985·Clinical and Laboratory Haematology·P R KelseyJ E Maciver
Feb 13, 1986·The New England Journal of Medicine·J L BlackJ R Skinner
Oct 1, 1983·American Journal of Clinical Pathology·N J PickeringS Ablaza
Sep 1, 1994·The Annals of Thoracic Surgery·W R WagnerG C Marrone
Aug 1, 1994·The Annals of Thoracic Surgery·L K von SegesserM I Turina
Aug 1, 1994·The Annals of Thoracic Surgery·M PeknaS Thelin
Aug 1, 1994·The Annals of Thoracic Surgery·E FosseP Venge
Aug 1, 1994·The Annals of Thoracic Surgery·A T CheungN Stenach
Jan 1, 1994·Annual Review of Medicine·P H Johnson
Aug 1, 1993·Journal of Cardiothoracic and Vascular Anesthesia·R M MoormanM E Comunale

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Citations

Dec 11, 2007·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Zachary N KonRobert S Poston
Feb 28, 2003·The Annals of Thoracic Surgery·David A Bull, Jennifer Maurer
Jun 1, 2000·Transfusion Science·D R Norfolk, J Seghatchian
Mar 12, 1999·Cardiovascular Surgery : Official Journal of the International Society for Cardiovascular Surgery·A ParolariP Biglioli
Feb 17, 2000·Artificial Organs·M J GartnerW R Wagner
Dec 22, 2005·The Annals of Thoracic Surgery·Robert S PostonBartley P Griffith
Nov 1, 1996·The Annals of Thoracic Surgery·E M BoyleB D Spiess
Mar 16, 2001·Expert Opinion on Pharmacotherapy·P P PunjabiK M Taylor
Mar 5, 2005·Journal of Cardiothoracic and Vascular Anesthesia·Rosaleen ChunDavid Royston
Oct 18, 2003·Anesthesiology Clinics of North America·Jeffrey A Green, Bruce D Spiess
May 31, 2014·Seminars in Cardiothoracic and Vascular Anesthesia·Stephen A EsperKenichi A Tanaka
May 9, 2007·Seminars in Cardiothoracic and Vascular Anesthesia·Emad B MossadJohn Apostolakis
Oct 18, 2005·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Laura Engles
Mar 20, 2009·Current Opinion in Anaesthesiology·Wulf Dietrich
Nov 6, 2007·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Thomas W Stief
Jul 5, 2008·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Andrea RosenkranzWolfgang Muntean
Jun 24, 2005·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Effie L GillespieCraig I Coleman
May 19, 2006·Pathophysiology of Haemostasis and Thrombosis·Simone FlightPaul Masci
Mar 20, 2008·Anesthesia and Analgesia·Michael P Eaton
Mar 3, 2006·Expert Review of Cardiovascular Therapy·Neel R SodhaFrank W Sellke
Nov 5, 2020·Cells·Denisa BojkovaJindrich Cinatl

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