Antifibrinolytic therapy during cardiopulmonary bypass reduces proinflammatory cytokine levels: a randomized, double-blind, placebo-controlled study of ϵ-aminocaproic acid and aprotinin

Abstract

When dosed in a similar manner, epsilon-aminocaproic acid seems to be as effective as aprotinin at reducing interleukin-6 and interleukin-8 levels in patients undergoing primary coronary artery bypass graft surgery. These data indicate that suppression of excessive plasmin activity or D-dimer formation or both may play an important role in the generation of proinflammatory cytokines during and after cardiopulmonary bypass.

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

“…These include: Ca 2þ (a requisite cofactor for many coagulation reactions), bicarbonate (as coagulation cascade reactions are impaired by acidosis), warming (since these reactions are also impaired by hypothermia), and anti-fibrinolytic agents (aprotinin Molenaar et al, 2001;Mossinger et al, 2003, aminocaproic acid Kang et al, 1987Porte et al, 1989;Greilich et al, 2003).…”

Aprotinin Reduces Cardiac Troponin I Release and Inhibits Apoptosis of Polymorphonuclear Cells During Off-Pump Coronary Artery Bypass Surgery

“…Many, but not all, studies in CPB-supported cardiac surgery have provided evidence for an anti-inflammatory action of aprotinin. [11][12][13][14][15][16][17][18][19][35][36][37] There seems to be conflicting evidence as to the presumed anti-inflammatory actions of aprotinin. On a theoretical basis and largely confirmed by in vitro investigations, aprotinin has potential antiinflammatory actions.…”

“…[8][9][10] Aprotinin has been demonstrated to reduce inflammation in CPB-supported cardiac surgery. [11][12][13][14][15][16][17][18][19] Whether aprotinin can further reduce inflammation in off-pump coronary artery bypass graft (OPCAB) surgery has currently not been investigated. In addition, aprotinin has been reported to have cardioprotective properties during cardiac surgery with CPB by reducing ischemia-reperfusion injury, including reduced cardiac troponin I (cTnI) release in coronary artery bypass graft (CABG) patients.…”

Estratégias para redução do uso de hemoderivados em cirurgia cardiovascular

“…Antifibrinolytic use reduces systemic inflammatory response in patients undergoing CPB [16], contributing to the reduction of postoperative bleeding [17,18]. Antifibrinolytics alone [15], or in association with hemoconcentration and re-infusion of all the remaining blood of CPB circuit, as well as the blood drained in the immediate postoperative period reduce the need of using blood products after cardiac surgery [15].…”

“…The preoperative procedure, beginning with erythropoietin or iron administration weeks before cardiac surgery [7,8] and autologous blood collection before surgical procedure [9]; 2. Strategies adopted during the cardiac surgery, such as reduction in prime volume and the use of equipment such as hemoconcentrators [8], cell saver device [10,11] and Biopump [12], moderate hypothermia (30-32ºC) [8], reinfusion of all blood remaining in the CBP circuit [13], and the use of antifibrinolytics, such as aprotinin, tranexamic acid, and epsilon-aminocaproic acid [14][15][16][17][18][19][20][21][22][23][24], as well as reinfusion of the blood collected by mediastinal drainage in the first six hours postoperatively [13].…”