The use of prostacyclin, PGI2, in the prevention of platelet aggregation during charcoal haemoperfusion.

In previous studies severe side effects, including irreversible hypotension, platelet losses and rises in Swank screen filtration pressure, have been recorded during the treatment by charcoal haemoperfusion of patients with fulminant hepatic failure. It has also been demonstrated that rises in Swank screen filtration pressure in an in vitro test circuit are due to the presence of platelet aggregates. In this study Prostacyclin was infused at a constant rate, to give a blood concentration of 5 ng/ml, into the in vitro circuit just prior to the charcoal column. Rises in Swank screen filtration pressure were prevented, and it was also shown that the giving of a bolus dose of Prostacyclin (400 ng/ml blood concentration) reversed rises in Swank screen filtration pressure that have already occurred. On the basis of these findings, Prostacyclin would be expected to be of considerable clinical value in the prevention of adverse platelet reactions to charcoal haemoperfusion when carried out in patients with fulminant hepatic failure.