HEMOSTATIC FUNCTION OF ASPIRIN-TREATED PLATELETS VULNERABLE TO CARDIOPULMONARY BYPASS - ALTERED SHEAR-INDUCED PATHWAY

被引:9
作者
TABUCHI, N
HUET, RCGG
STURK, A
EIJSMAN, L
WILDEVUUR, CRH
机构
[1] UNIV GRONINGEN HOSP,CTR THORAX,LEIDEN,NETHERLANDS
[2] UNIV GRONINGEN HOSP,DEPT ANESTHESIA,LEIDEN,NETHERLANDS
[3] UNIV LEIDEN HOSP,DEPT CLIN CHEM,2300 RC LEIDEN,NETHERLANDS
[4] ACAD MED CTR,DEPT CARDIOPULM SURG,AMSTERDAM,NETHERLANDS
关键词
D O I
10.1016/S0022-5223(95)70115-X
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The impaired hemostasis of aspirin-treated patients is an annoying problem during and after cardiopulmonary bypass, The hemostatic function of platelets comprises two mechanisms: the shear-induced and the cyclooxygenase pathways, Because the latter is inhibited in aspirin-treated patients, the hemostatic function depends mainly on the former pathway, To investigate the effect of cardiopulmonary bypass on the shear-induced pathway, a double-blind study of preoperative aspirin treatment (325 mg) and placebo was conducted in 40 patients undergoing coronary artery bypass grafting, Postoperative blood loss was higher in the aspirin-treated patients than in the placebo-treated patients (p < 0.05), The shear-induced hemostasis was monitored by the in vitro bleeding test (Thrombostat), which mimics bleeding through an injured arteriole, The shear-induced pathway of aspirin-treated platelets was not affected before cardiopulmonary bypass, but it was impaired more during the operation (p < 0.01) and remained worse afterward (p < 0.05), compared with that of placebo-treated platelets, The inhibitory effects of aspirin on thromboxane production and on collagen-induced platelet aggregation remained throughout the operation, In aspirin-treated platelets, the aggregation capacity induced by adenosine diphosphate was inhibited before the operation (p < 0.05) and showed substantial recovery during the operation (p < 0.05), These results suggest that the shear-induced pathway of aspirin-treated platelets is more vulnerable to cardiopulmonary bypass than the pathway in normal platelets and causes severe impairment of hemostasis afterward.
引用
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页码:813 / 818
页数:6
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