Tanaka K, Kondo C, Takagi K, Sato T, Yada I, Yuasa H, Kusagawa M
Department of Thoracic Surgery, Mie University School of Medicine, Japan.
ASAIO J. 1993 Jul-Sep;39(3):M545-9.
The effect of nafamostat mesilate (FUT-175) on platelet membrane glycoproteins and the coagulofibrinolytic system were analyzed. Twenty-five patients undergoing aorto-coronary bypass surgery were randomly distributed into an FUT treated group and a control group. In the control group, anticoagulation was achieved with sodium heparin (3 mg/kg) immediately before cardiopulmonary bypass (CPB). In the FUT treated group, in addition to the usual treatment with heparin, FUT-175 was infused continuously at a rate of 2 mg/kg/hr. In the control group, alpha 2 plasmin inhibitor/plasmin complex (PIC) and fibrinogen/fibrin degradation products (FDP) D-dimer increased significantly during CPB, reaching 6.1 +/- 5.1 micrograms/ml and 576 +/- 200 ng/ml, respectively, at 60 min of CPB. PIC and FDP D-dimer remained significantly lower in the FUT treated group than in the control group. GPIb on platelets decreased significantly in both groups, but remained higher in the FUT treated group (81 +/- 5% vs. 56 +/- 21% at 60 min of CPB, P < 0.01). There were no significant changes in GPIIb/IIIa on platelets throughout the procedure in either group. Blood loss after CPB was significantly lower in the FUT treated group than in the control group (778 +/- 277 ml vs. 1,342 +/- 426 ml, P < 0.01). The authors conclude that FUT-175 improves hemostasis after CPB, not only by inhibiting fibrinolysis, but also by preserving platelet GPIb during CPB.
分析了甲磺酸萘莫司他（FUT - 175）对血小板膜糖蛋白及凝血纤溶系统的影响。25例行主动脉冠状动脉搭桥手术的患者被随机分为FUT治疗组和对照组。对照组在体外循环（CPB）前即刻用肝素钠（3mg/kg）进行抗凝。在FUT治疗组中，除了常规肝素治疗外，FUT - 175以2mg/kg/小时的速率持续输注。在对照组中，CPB期间α2纤溶酶抑制剂/纤溶酶复合物（PIC）和纤维蛋白原/纤维蛋白降解产物（FDP）D - 二聚体显著增加，在CPB 60分钟时分别达到6.1±5.1微克/毫升和576±200纳克/毫升。FUT治疗组的PIC和FDP D - 二聚体仍显著低于对照组。两组血小板上的糖蛋白Ib（GPIb）均显著降低，但FUT治疗组仍较高（CPB 60分钟时为81±5%对56±21%，P<0.01）。两组在整个过程中血小板上的糖蛋白IIb/IIIa（GPIIb/IIIa）均无显著变化。FUT治疗组CPB后的失血量显著低于对照组（778±277毫升对1342±426毫升，P<0.01）。作者得出结论，FUT - 175不仅通过抑制纤溶，还通过在CPB期间保留血小板GPIb来改善CPB后的止血。
