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The Annals of Thoracic Surgery, Vol 55, 652-658, Copyright © 1993 by The Society of Thoracic Surgeons
J Boldt, C Knothe, B Zickmann, S Bill, F Dapper and G Hempelmann
Hypothermic cardiopulmonary bypass (CPB) has been associated with both
coagulation defects and hemorrhage. The influence of temperature on
platelet function and the benefits of aprotinin in this situation were
studied in 60 patients undergoing elective aortocoronary bypass grafting.
The patients were randomly divided into four groups (15 patients per
group): group 1, normothermic CPB (nasopharyngeal temperature > 34
degrees C); group 2, normothermic bypass and administration of high-dose
aprotinin (2 million IU before CPB, 500,000 IU/h until the end of the
operation, and 2 million IU added to the prime); group 3, hypothermic CPB
(nasopharyngeal temperature < 28 degrees C); and group 4, hypothermic
CPB and aprotinin. Platelet function was evaluated by aggregometry
(turbidimetric technique), and aggregation was induced by adenosine
diphosphate (1 and 2 mumol/L), collagen (4 micrograms/L), and epinephrine
(25 mumol/L) before, during, and after CPB into the first postoperative
day. Starting from comparable baseline values, maximum platelet aggregation
and maximum gradient of platelet aggregation were significantly most
reduced after CPB in group 3 (hypothermic CPB without aprotinin) (ranging
from -30% to -53% relative to baseline values). In comparison with the
other groups, platelet function in this group also recovered less quickly
in the later post-bypass period. Hypothermic CPB with aprotinin resulted in
less-altered platelet function than hypothermic CPB without aprotinin.
Platelet aggregation in aprotinin-treated patients was comparable overall
with that in patients undergoing normothermic CPB. On the first
postoperative day, aggregation variables had returned to or exceeded
baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Platelet function in cardiac surgery: influence of temperature and aprotinin
Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig- University, Giessen, Germany.
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