Mengistu Andinet M, Röhm Kerstin D, Boldt Joachim, Mayer Jochen, Suttner Stefan W, Piper Swen N
Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstrasse 79, D-67063 Ludwigshafen, Germany.
Anesth Analg. 2008 Aug;107(2):391-7. doi: 10.1213/ane.0b013e31817b7732.
Antifibrinolytic drugs including aprotinin and tranexamic acid are currently used in cardiac surgery to reduce postoperative bleeding and transfusion requirements, and may have different effects on platelets. We therefore evaluated platelet function after cardiopulmonary bypass (CPB) and cardiac surgery to determine the effect of either aprotinin or tranexamic acid.
In a prospective, randomized study, 50 patients scheduled for elective cardiac surgery with CPB were evaluated. Patients received high-dose aprotinin (n = 25) or tranexamic acid (n = 25) as antifibrinolytic drugs. Coagulation and platelet function were assessed preoperatively, after CPB, 3 and 24 h after surgery using modified thrombelastography and whole blood aggregometry.
Impaired coagulation after CPB occurred in both groups compared with preoperative data (P < 0.01). In contrast to modified thrombelastography, thrombin receptor-mediated aggregometry after CPB was significantly decreased only in those patients receiving tranexamic acid until the end of the study period in comparison to the aprotinin group (P < 0.05). Aprotinin-treated patients showed significantly less chest tube drainage (575 mL +/- 228 vs 1033 mL +/- 647, P < 0.05) and need for postoperative transfusion requirements (P < 0.01) compared with the tranexamic acid group.
Platelet function measured by whole blood aggregometry is better preserved by aprotinin than tranexamic acid and may be responsible for producing less bleeding within the first 24 h after CPB.
包括抑肽酶和氨甲环酸在内的抗纤溶药物目前用于心脏手术，以减少术后出血和输血需求，并且可能对血小板有不同影响。因此，我们评估了体外循环（CPB）和心脏手术后的血小板功能，以确定抑肽酶或氨甲环酸的效果。
在一项前瞻性随机研究中，对50例计划接受择期CPB心脏手术的患者进行了评估。患者接受高剂量抑肽酶（n = 25）或氨甲环酸（n = 25）作为抗纤溶药物。术前、CPB后、术后3小时和24小时使用改良血栓弹力图和全血凝集试验评估凝血和血小板功能。
与术前数据相比，两组CPB后凝血均受损（P < 0.01）。与改良血栓弹力图不同，与抑肽酶组相比，CPB后凝血酶受体介导的凝集试验仅在接受氨甲环酸的患者中在研究期结束前显著降低（P < 0.05）。与氨甲环酸组相比，接受抑肽酶治疗的患者胸腔引流显著减少（575 mL ± 228 vs 1033 mL ± 647，P < 0.05），术后输血需求也减少（P < 0.01）。
通过全血凝集试验测量的血小板功能，抑肽酶比氨甲环酸保存得更好，这可能是CPB后24小时内出血较少的原因。
