Improved hemostasis with the combination of a heparin-coated circuit and aprotinin prime during open-heart surgery: Potentiating effect on platelet preservation

Aprotinin administration with or without a heparin-coated circuit is expected to modulate subclinical plasma coagulation and fibrinolysis and platelet function during cardiopulmonary bypass. We studied the effect of the application of both, either one, or neither of an aprotinin prime (100 million KIU) and heparin-coated circuit in 32 consecutive patients undergoing coronary artery bypass surgery randomly divided into four groups of 8 patients each. Aprotinin was not used with the non-heparin-coated circuit in the control group. Levels of fibrinopeptide A were significantly lower in the heparin-coated circuit groups (P < 0.05-0.01), irrespective of an aprotinin prime. D-dimer levels in the control group were significantly higher than in the other groups (P < 0.05-0.01). The preservation rates of platelet count and function (acceleration of coagulation by platelet activating factor) in the control group were significantly lower than in the other three groups (P < 0.05-0.01). Platelet preservation in the aprotinin plus heparin-coated group was significantly better than in the aprotinin only and the heparin-coated only groups (P < 0.05). The amount of mediastinal drainage and the units of blood transfusion were significantly reduced in the two aprotinin groups, irrespective of heparin-coated use (P < 0.01). The values in the aprotinin plus heparin-coated group were significantly less than the values in the heparin-coated only group (P < 0.05). The heparin-coated circuit was beneficial for suppressing subclinical plasma coagulation and fibrinolysis and for preserving platelets. Addition of the minimal-dose aprotinin prime further preserved platelet function and offered the possibility of bringing about a further reduction in postoperative blood loss and blood requirements.