A Heparin‐Coated Circuit Reduces Complement Activation and the Release of Leukocyte Inflammatory Mediators During Extracorporeal Circulation in a Rabbit

Fb, Plötz; Oeveren, van Willem; Hultquist, K. A.; Miller, C. W.; Bartlett, R. H.; Wildevuur, Charles

doi:10.1111/j.1525-1594.1992.tb00533.x

Cited by 23 publications

(3 citation statements)

References 20 publications

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“…1,19 The inflammatory response to ECC has been investigated by many research groups. 20,21 Additionally, ECC-related anticoagulation might be associated with a higher risk for bleeding in stroke patients. In the past decade, several neurological studies have investigated isovolemic or hypervolemic hemodilution as a treatment option for stroke patients to lower viscosity and increase cerebral blood flow in the penumbra zone.…”

Section: Discussionmentioning

confidence: 99%

Neurological Outcome of Septic Cardioembolic Stroke After Infective Endocarditis

Ruttmann

Willeit

Ulmer

et al. 2006

Stroke

241

124

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Background and Purpose-The aim of this study was to evaluate mortality and neurological outcomes of cardioembolic cerebral stroke in infective endocarditis (IE) patients requiring cardiac surgery. Methods-A consecutive series of 214 patients undergoing cardiac surgery for IE was followed up for 20 years. In 65 patients (mean age, 52 years), IE was complicated by computed tomography-or magnetic resonance imaging-verified stroke (nϭ61) or transient ischemic attack (nϭ4). Perioperative (30-day) and long-term mortality was assessed with regression models adjusting for age. Complete neurological recovery of IE survivors was defined by a modified Rankin score of Յ1 and a Barthel index of 20 points. Results-Fifty of 61 stroke patients (81.9%) survived surgery. In comparison with nonstroke patients, the age-adjusted perioperative mortality risk was 1.70-fold (95% CI, 0.73 to 3.96, Pϭ0.22) higher and long-term mortality risk was 1.23-fold (95% CI, 0.72 to 2.11, Pϭ0.45) higher in stroke patients. Patients with complicated stroke (meningitis, hemorrhage, or brain abscess) showed a higher perioperative mortality rate (38.9% vs 8.5%, Pϭ0.007) but no higher neurological complication rate than patients with uncomplicated ischemic stroke. Complete neurological recovery was achieved in 35 IE survivors (70%, 95% CI, 55% to 82%). However, in the case of middle cerebral artery stroke, recovery was only 50% and was significantly lower compared with non-middle cerebral artery stroke (Pϭ0.012). Conclusion-Uncomplicated IE-related stroke showed a favorable prognosis with regard to both long-term survival and neurological recovery. The formidable risk of secondary cerebral hemorrhage due to cardiac surgery seems to be much lower than previously thought.

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Section: Discussionmentioning

confidence: 99%

Neurological Outcome of Septic Cardioembolic Stroke After Infective Endocarditis

Ruttmann

Willeit

Ulmer

et al. 2006

Stroke

241

124

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“…Heparin-coated circuits reduce cytokine release, complement activation in vivo and in vitro , kallikrein, and leukocyte activation ( 180 – 184 ). They have been shown to reduce platelet adhesion and improve platelet function, as well as inhibit the release of pro-inflammatory cytokines TNF-α, IL-6, IL-8 as well as soluble TNF receptors ( 180 , 185 – 187 ). Significant reduction in mean concentrations of polymorphonuclear (PMN) elastase and soluble C5b-9 ( p < 0.001 and p = 0.006, respectively) at one hour following initiation of CPB have been reported.…”

Section: Strategies To Modulate Cpb-associated Inflammatory Responsementioning

confidence: 99%

Strategies to attenuate maladaptive inflammatory response associated with cardiopulmonary bypass

Banerjee,

Feng,

Sellke

2024

Front. Surg.

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Cardiopulmonary bypass (CPB) initiates an intense inflammatory response due to various factors: conversion from pulsatile to laminar flow, cold cardioplegia, surgical trauma, endotoxemia, ischemia-reperfusion injury, oxidative stress, hypothermia, and contact activation of cells by the extracorporeal circuit. Redundant and overlapping inflammatory cascades amplify the initial response to produce a systemic inflammatory response, heightened by coincident activation of coagulation and fibrinolytic pathways. When unchecked, this inflammatory response can become maladaptive and lead to serious postoperative complications. Concerted research efforts have been made to identify technical refinements and pharmacologic interventions that appropriately attenuate the inflammatory response and ultimately translate to improved clinical outcomes. Surface modification of the extracorporeal circuit to increase biocompatibility, miniaturized circuits with sheer resistance, filtration techniques, and minimally invasive approaches have improved clinical outcomes in specific populations. Pharmacologic adjuncts, including aprotinin, steroids, monoclonal antibodies, and free radical scavengers, show real promise. A multimodal approach incorporating technical, circuit-specific, and pharmacologic strategies will likely yield maximal clinical benefit.

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“…Its action on the burn probably derives from its anti-inflammatory and angiogenic properties that do not depend on its´ well-known anticoagulant action 8,9 . The anti-inflammatory action results from deactivation of pro-inflammatory cytokines such as TNF-alpha 10 , selectins secreted by leukocytes such as CD11b 11,12 integrins such as ICAM-1 13 and attenuation of complement activation 14 . Angiogenic effect derives from the interaction with vascular endothelium growth factor (VEGF) 15,16 and with fibroblasts' growth factors (FGFs) 17,18 .…”

Section: Introductionmentioning

confidence: 99%

Estudo comparativo entre tratamento convencional e tratamento com heparina tópica para a analgesia de queimaduras

Barretto¹,

Costa²,

Serra³

et al. 2010

Rev. Assoc. Med. Bras.

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Objective. This prospective, randomized, open-label study controlled by active comparator aimed at assessing analgesic efficacy and overall tolerability of a burn treatment based on topic administration of unfractionated heparin. MethOds. Fifty eight male or female patients were randomly selected for conventional treatment (C group) or topical heparin treatment (TH group). Ages of patients enrolled ranged from 18 to 55 years. They had 2nd and 3rd degree burns on 10% to 30% of the body surface (BS) caused by fire or scald, no history of hemorrhagic diatheses, no hypersensitivity to heparin and less than 10% of the BS burned to 3rd degree. C group had frequent balneotherapy for injuries debridement and received silver sulfadiazine dressings. TH group had the first debridement and their burnt areas were left exposed to receive 4200 IU of unfractionated heparin topically for each 1% of burned BS, three times daily. Analgesic efficacy was evaluated in the 38 patients who completed the study according to the demand of analgesic medications and response to the pain Visual Analog Scale (VAS). Tolerability was evaluated from the files of all 58 randomized patients by the comparative incidence of adverse reactions. Results. The TH group demanded less analgesic medications (11.83 ± 9.38 per patient against 33.35 ± 20.63 for the group C, p<0.01), reported less pain in the VAS, had less fever and more bleeding than C group. There was no difference in the incidence of local infection, septicemia and safety exams. cOnclusiOn. The TH scheme presented higher analgesic effectiveness than C scheme without important tolerability problems.

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A Heparin‐Coated Circuit Reduces Complement Activation and the Release of Leukocyte Inflammatory Mediators During Extracorporeal Circulation in a Rabbit

Cited by 23 publications

References 20 publications

Neurological Outcome of Septic Cardioembolic Stroke After Infective Endocarditis

Neurological Outcome of Septic Cardioembolic Stroke After Infective Endocarditis

Strategies to attenuate maladaptive inflammatory response associated with cardiopulmonary bypass

Estudo comparativo entre tratamento convencional e tratamento com heparina tópica para a analgesia de queimaduras

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