Does low dose of aprotiniminfluence haemostatic profile in-patients under going mitral valve replacement ?

Abstract EN

Aprotinin (Trasylol), a non-specific serine protease inhibitor, is successful used to reduce excessive postoperative bleeding during cardiopulmonary bypass.

The aim of our study was to verify the hypothesis whether aprotinin used during cardiopulmonary bypass procedure affects hemostatic parameters, which might be crucial for the elevated risk of thromboembolic complications.

Patients and methods: Thirty patients undergoing open heart surgery for valve replacement were divided into two equal groups.

Group 1 (Aprotinin group, AP) (N = 15) a loading dose of 1,000,000 u was given over 20 minutes before sternotomy followed by a constant infusion of500,000 U/h and 1,000,000 U was added to the priming.

Group 2 (Control group) (N =15) no antifibrinolytic medications were given to this group of' patients.

Anesthesia and cardiopulmonary bypass protocol were standard for all patients.

Plasma level of (Hemoglobin, Hematocrit, Platelet), and Coagulation profile were measured.

All blood samples were withdrawn in all patients at 6 times, before induction of anesthesia (basal), post CPB, at 1CU arrival, after 6, 12 and 24 hours from ICU arrival.

Postoperative, blood loss from the mediastinal chest tubes was collected and reported at 6, 12, and 24 hours from the time of arrival to ICU.

The percentage of patients received transfusion and the number of transfused units of packed red blood cells (PRBC), platelet and fresh frozen plasma were estimated and recorded at the end of CPB and at the time of discharge from the hospital.

Results: At the end of CPB, the thrombin time decreased in group 1 but this decrease was with in normal range (38-54 seconds) and elevated to exceed the normal range in group (2), This change in thrombin time returned gradually to the baseline value at the end of the study (2 4 hours from ICU arrival) in groups (1), but still exceeded the normal range in group (2) till the end of the study.

The fibrinogen level was decreased at the end of CPB in all the studied groups.

It began to return to the baseline value in groups (1) at 12 and 24 hours from ICU arrival but the level still lower in group (2) till the end of the study.

The D-dimer level was elevated at the end of CPB in all the studied groups and began to return to the normal value in groups (1) ai 12 and 24 hours from ICU arrival but the level was markedly elevated and exceeded the normal value in group (2) till the end of the study.

The amount of blood loss was significantly reduced (P < 0.05) in groups (1) when compared with group (2) at all the time of study.

The amount of transfused (PRBC) units, FFP and Platelet were significantly decreased (P < 0.05) in group (1) when compared to control group.

Conclusion: Low dose aprotinin during mitral valve replacement surgery decreased preoperative blood loses and the need for allergenic transfusion together with improvement the haemostatic profile