Iloprost Reduces Procoagulant Activity in the Extracorporeal Circuit

Although activation of formed blood elements during cardiopulmonary bypass has been examined, its presumed procoagulant role has not been identified or quantified. We evaluated the effects of iloprost, an inhibitor of platelet and leukocyte function, on subclinical coagulation during simulated extra...

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Veröffentlicht in:The Journal of surgical research 1993-10, Vol.55 (4), p.433-440
Hauptverfasser: Korn, Robert L., Fisher, Carol A., Stenach, Nina, Jeevanandam, Valluvan, Addonizio, V.Paul
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Sprache:eng
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Zusammenfassung:Although activation of formed blood elements during cardiopulmonary bypass has been examined, its presumed procoagulant role has not been identified or quantified. We evaluated the effects of iloprost, an inhibitor of platelet and leukocyte function, on subclinical coagulation during simulated extracorporeal circulation. We determined that a heparin dose of 1 U/ml prevented clot formation in this model, but resulted in elevated plasma levels of fibrinopeptide A, the first cleavage product of fibrinogen. Human blood was recirculated with 1 U/ml heparin using a roller pump and pediatric reversed hollow fiber oxygenator (0.8 m 2) for 2 hr at 37°C. Iloprost (1 ng/ml, n = 5) reduced platelet adhesion, with platelet counts of 78 ± 7% (X̄ ± SEM) of baseline during 2 hr of simulated extracorporeal circulation, compared to 36 ± 6% in control circuits (CONT: n = 6, P < 0.05). Plasma levels of platelet factor 4 and β-thromboglobulin were also reduced by iloprost (486 ± 116 ng/ml vs CONT, 2933 ± 275 ng/ml, P < 0.05, and 938 ± 274 ng/ml vs CONT, 5700 ± 1109 ng/ml, P < 0.05, respectively). Circulating leukocyte counts were maintained in iloprost circuits (6.4 ± 0.6 × 10 3/mm 3 vs CONT, 4.2 ± 0.3 × 10 3/mm 3, P < 0.05), and neutrophil elastase levels rose to only 0.4 ± 0.1 ng/ml in iloprost circuits, compared to 0.8 ± 0.1 ng/ml in CONT ( P < 0.05). Finally, iloprost treatment reduced fibrinopeptide A levels to 102 ± 28 ng/ml (CONT, 793 ± 337 ng/ ml, P < 0.05) after 2 hr. These fibrinopeptide A levels are equivalent to those of fully heparinized circuits (5 U/ml, 88 ± 49 ng/ml, n = 6, NS). Iloprost thus reduced activation of platelets and leukocytes despite 2 hr of recirculation with low-dose heparin. For the first time, these data demonstrate that cellular inhibition can reduce activation of coagulant proteins and consequent hromhosis during simulated extracorporeal circulation.
ISSN:0022-4804
1095-8673
DOI:10.1006/jsre.1993.1165