Is there a phase of hypercoagulability when aprotinin is usedin cardiac surgery?

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Abstract
To determine a possible phase of hypercoagulability after the use ofhigh-dose aprotinin, a prospective randomized double-blind study wasperformed. Twenty patients undergoing aortocoronary bypass surgery wereinvestigated, a placebo group P (n = 10) was compared to an aprotinin groupA (n = 10). Examining parameters of thrombin activation and fibrinolysis,we found during extracorporeal circulation--under continuous aprotinininfusion--a significant inhibition of thrombin activation and fibrinolysisin the aprotinin group (thrombin- antithrombin-III-complexes: 95 +/- 23micrograms/l, d-dimers: 448 +/- 60 ng/ml, plasminogen activity: 33 +/- 3%,plasminogen activator inhibitor: 98 +/- 14 U/ml) compared to the placebogroup (thrombin- antithrombin-III-complexes: 143 +/- 13 micrograms/l,d-dimers: 2755 +/- 430 ng/ml, plasminogen activity: 125 +/- 15%,plasminogen activator inhibitor: 10 +/- 4 U/ml). In contrast, afterstopping the aprotinin infusion--from the end of extracorporeal circulationuntil the morning of the first postoperative day--strong thrombinactivation took place in the aprotinin group (d-dimers increased from 472+/- 90 to 1607 +/- 140 ng/ml), while in the placebo group a decrease couldbe registered. At this time, the fibrinolysis was still reduced in theaprotinin group (plasminogen activity: 48 +/- 6% vs 85 +/- 16% in theplacebo group). In conclusion, interference with the thrombohemorrhagicbalance induces hypercoagulability after the use of high-dose aprotinin,with elevated levels of thrombin-antithrombin-III-complexes, d-dimers, andplasminogen and a decreased level of plasminogen activator inhibitor. Inour opinion, it is necessary to prevent this counter- regulation.(ABSTRACTTRUNCATED AT 250 WORDS)

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