Aprotinin effect on platelet function and clotting during cardiopulmonary bypass

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Abstract
A variety of studies have been performed on the preservation ofhemostasis by aprotinin during cardiopulmonary bypass (CPB). It appearsthat the mechanism of aprotinin to preserve hemostasis can be interpretedin different ways. Our previous studies suggested that preservation ofplatelet glycoprotein Ib (GpIb) antigen, and counteraction of heparinanticoagulation in the extrinsic clotting pathway might partly explain thepreservative effect of aprotinin. A clinical study was therefore conductedto evaluate these effects during the use of low dose aprotinin. Improvedagglutination by ristocetin (P < 0.05), and improved GpIb antigenexpression (P < 0.05) during CPB showed better preserved plateletadhesive capacity in the aprotinin group than in the control group.Glycoprotein Ib antigen expression and the agglutination capacity withristocetin during CPB were closely related (P < 0.05). PlateletGpIIb/IIIa antigen and adenosine diphosphate (ADP) aggregation were notsignificantly different between the aprotinin and control groups. Aprotininhad no effect on the extrinsic clotting pathway in the blood, since thethromboplastin clotting time was similar in both groups. These resultsindicate that the protection of platelet adhesive capacity during CPB is amain function of aprotinin, whereas no evidence was collected for enhancedextrinsic clotting by aprotinin during CPB.

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