Efficacy of FK633, an ultra-short acting glycoprotein IIb/IIIa antagonist on platelet preservation during and after cardiopulmonary bypass

Tabata, Shigeki; Yamaguchi, Syohjiro; Nagamine, Hiroshi; Tomita, Shigeyuki; Arai, Sadahiko; Takemura, Hirofumi; Watanabe, Go

doi:10.1016/j.ejcts.2004.03.036

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…This systematic review and meta-analysis showed that thrombocytopenia has a considerable prevalence (up to 21%) in ECMO patients. Thrombocytopenia has been demonstrated in patients undergoing different mechanical circulatory support (cardiopulmonary bypass, intra-aortic balloon pump, left ventricular assist device (LVAD)) [41][42][43][44][45][46] (Figure 4 in Supplemental material). The origin of thrombocytopenia is likely multifactorial (contact with foreign surfaces, platelet activation, inflammatory and coagulative cascade activation), with sepsis, medications, surgery, bleeding, intravascular devices, and blood transfusions as contributing factors [41][42][43] (Figure 3 and Figure 4 in Supplemental material).…”

Section: Discussionmentioning

confidence: 99%

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

et al. 2020

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Despite increasing improvement in extracorporeal membrane oxygenation (ECMO) technology and knowledge, thrombocytopenia and impaired platelet function are usual findings in ECMO patients and the underlying mechanisms are only partially elucidated. The purpose of this meta-analysis and systematic review was to thoroughly summarize and discuss the existing knowledge of platelet profile in adult ECMO population. All studies meeting the inclusion criteria (detailed data about platelet count and function) were selected, after screening literature from July 1975 to August 2019. Twenty-one studies from 1.742 abstracts were selected. The pooled prevalence of thrombocytopenia in ECMO patients was 21% (95% CI 12.9-29.0; 14 studies). Thrombocytopenia prevalence was 25.4% (95% CI 10.6-61.4; 4 studies) in veno-venous ECMO, whereas it was 23.2% (95% CI 11.8-34.5; 6 studies) in veno-arterial ECMO. Heparin-induced thrombocytopenia prevalence was 3.7% (95% CI 1.8-5.5; 12 studies). Meta-regression revealed no significant association between ECMO duration and thrombocytopenia. Platelet function impairment was described in 7 studies. Impaired aggregation was shown in 5 studies, whereas loss of platelet receptors was found in one trial, and platelet activation was described in 2 studies. Platelet transfusions were needed in up to 50% of the patients. Red blood cell transfusions were administered from 46 to 100% of the ECMO patients. Bleeding events varied from 16.6 to 50.7%, although the cause and type of haemorrhage was not consistently reported. Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode. The underlying mechanisms are multifactorial, and understanding and management are still limited. Further research to design appropriate strategies and protocols for its monitoring, management, or prevention should be matter of thorough investigations.

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Section: Discussionmentioning

confidence: 99%

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

et al. 2020

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“…Typical pharmacologic means have focused on anti-fibrinolytic agents but could also focus on intraoperative adjuncts for the prevention of platelet dysfunction (7, 22) or the promotion of hemostasis with fibrinogen concentrate (21) or recombinant factor VII (23). The etiology of preoperative anemia in patients undergoing elective cardiac operations has been described and it is suggested that in the majority of patients the anemia is preventable (24).…”

Section: Discussionmentioning

confidence: 99%

Predictors of massive transfusion with thoracic aortic procedures involving deep hypothermic circulatory arrest

Williams

Phillips-Bute

Bhattacharya

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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Background Massive perioperative blood product transfusion may be required with thoracic aortic operations and is associated with poor outcomes. Our objective was to determine the independent predictors of massive transfusion in thoracic aortic surgery patients undergoing deep hypothermic circulatory arrest (DHCA). Methods The study consisted of 168 consecutive patients undergoing open thoracic aortic procedure utilizing DHCA between July 2005 and August 2008. We identified 26 preoperative and procedural variables as being potentially related to blood product usage. We tested the variables for association with total blood products transfused using a multivariate linear regression model and then constructed a logistic regression model for massive transfusion, defined as requiring 5 or more units of transfused packed red blood cells between incision and 48 hours postoperatively. Results Multivariate linear regression determined six significant variables as accounting for 42% of the variation in total blood products transfused: age (P=0.008), preoperative hemoglobin (P=0.04), weight (P=0.02), cardiopulmonary bypass time (P<0.0001), emergent status (P<0.0001), and re-do median sternotomy (P<0.0001). A final predictive logistic regression model associated every 1 g/dL increase in preoperative hemoglobin OR=0.54 [0.43, 0.69], P<0.0001; every 10 minute increase in CPB time, OR=1.15 [1.05, 1.26], P=0.0026; and emergent status OR=4.02 [1.53, 10.55], P=0.0047 with massive transfusion. Conclusions Our model described CPB time, emergent status, and preoperative hemoglobin as independent predictors of massive transfusion. These variables, along with weight, age, and re-do median sternotomy are associated with total blood product usage in thoracic aortic operations involving DHCA.

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“…Nitric oxide has the advantages of being very short-acting and may be administered via the oxygenator, which has the largest surface area for contact activation of the CPB circuit. The ultrashort-acting glycoprotein IIb-IIIa antagonist FK633 was shown to be effective in preventing CPB-induced thrombocytopenia and preventing platelet adhesion to the circuit (101). Little attention has been given to platelet anesthesia in pediatric cardiac surgery, but attenuation of the platelet response seems an obvious therapy to 'complete' anticoagulation for CPB.…”

Section: Platelet Anesthesiamentioning

confidence: 99%

Coagulation considerations for infants and children undergoing cardiopulmonary bypass

Eaton

Iannoli

2010

Pediatric Anesthesia

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Cardiac surgery involving cardiopulmonary bypass imposes a significant pathophysiologic burden on patients. Pediatric patients are especially predisposed to the adverse effects of surgery and bypass on the coagulation system, with resultant bleeding, transfusion, and poor outcomes. These risks accrue to pediatric patients in inverse proportion to their weight and are attributable to hematologic immaturity, coagulation defects associated with congenital heart disease, bypass equipment, and the nature of congenital heart surgery. Standard anticoagulation does not completely inhibit thrombin generation, and continuous consumption of coagulation factor continues throughout bypass. Conventional measurements of anticoagulation during bypass poorly reflect this incomplete anticoagulation, and alternate methods may improve anticoagulant therapy. Emerging therapies for blocking the effects of bypass on the coagulation system hold promise for decreasing bleeding and related complications, and improving outcomes in congenital heart surgery.

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Efficacy of FK633, an ultra-short acting glycoprotein IIb/IIIa antagonist on platelet preservation during and after cardiopulmonary bypass

Abstract: An ultra-short acting glycoprotein IIb/IIIa antagonist, FK633, is effective in preventing both platelet aggregation and thrombocytopenia during CPB, and may be effective for minimizing postoperative bleeding.

Cited by 8 publications

References 17 publications

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

Predictors of massive transfusion with thoracic aortic procedures involving deep hypothermic circulatory arrest

Coagulation considerations for infants and children undergoing cardiopulmonary bypass

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