Aprotinin inhibits thrombin formation and monocyte tissue factor in simulated cardiopulmonary bypass

• Published in: The Annals of thoracic surgery Vol. 68; no. 2; pp. 473 - 478
• Main Authors: Khan, Mohammad M.H, Gikakis, Nicolas, Miyamoto, Shinji, Rao, A.Koneti, Cooper, Stuart L, Edmunds, L.Henry, Colman, Robert W
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.08.1999; Elsevier Science
• Subjects: Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antithrombin III - metabolism; Aprotinin - pharmacology; Biological and medical sciences; Cardiopulmonary Bypass; Factor VIIa - antagonists & inhibitors; Hemostatics - pharmacology; Humans; Macrophage-1 Antigen - metabolism; Medical sciences; Models, Cardiovascular; Monocytes - drug effects; Peptide Fragments - metabolism; Peptide Hydrolases - metabolism; Prothrombin - metabolism; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Thromboplastin - metabolism; Human origin; Pharmacologic test; Membrane oxygenator; Monocyte; Coagulation; Tissue factor; Exploration; Biosynthesis; Blood; Cardiopulmonary bypass; Thrombin(drug); Simulation; Aprotinin; Inhibition
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(99)00551-2

Background. Aprotinin reduces perioperative bleeding after open heart surgery, primarily by inhibiting fibrinolysis. In addition, the drug has both procoagulant and anticoagulant effects that involve complex reactions of coagulation proteins and cells that are incompletely understood. This study tests the hypothesis that aprotinin has an anticoagulant effect on the extrinsic coagulation pathway. Methods. Human heparinized blood was recirculated through a membrane oxygenator with and without high concentrations of aprotinin (18.4 μM). Serial plasma samples were obtained at intervals up to 240 minutes. Results. Aprotinin significantly reduced the progressive increase in prothrombin fragments (F1.2) and thrombin-antithrombin complex beginning immediately. Aprotinin also significantly reduced monocyte expression of tissue factor and Mac-1. Aprotinin did not significantly reduce factor VII or factor VIIa. Conclusions. During simulated cardiopulmonary bypass, aprotinin immediately inhibits kallikrein and thrombin formation via the intrinsic coagulation pathway. Later, aprotinin inhibits monocyte expression of tissue factor and the extrinsic coagulation pathway. The ability of aprotinin to inhibit monocyte tissue factor provides a means to reduce thrombin formation in blood aspirated from the wound during open heart surgery.