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Aprotinin and the systemic inflammatory response after cardiopulmonary bypass.

Publication ,  Journal Article
Mojcik, CF; Levy, JH
Published in: Ann Thorac Surg
February 2001

Cardiopulmonary bypass is associated with a systemic inflammatory response, a spectrum of pathophysiologic changes ranging from mild organ dysfunction to multisystem organ failure. Complications include coagulation disorders (bleeding diathesis, hyperfibrinolysis) from platelet defects and plasmin activation, as well as pulmonary dysfunction from neutrophil sequestration and degranulation. Diverse injuries are a consequence of multiple inflammatory mediators (complement, kinins, kallikrein, cytokines). Both plasmin and kallikrein amplify the inflammatory response by activating components of the contact activation system. The full-Hammersmith (high dose) of aprotinin, a serine protease inhibitor approved for reducing blood loss and transfusion requirements in cardiopulmonary bypass, inhibits kallikrein and plasmin, resulting in suppression of multiple systems involved in the inflammatory response. Specifically, inhibition of factor XII, bradykinin, C5a, neutrophil integrin expression, elastase activity, and airway nitric oxide production are observed. Clinical correlates include reduced capillary leak, preserved systemic vascular resistance and blood pressure, and improved myocardial recovery following ischemia. Overall, evidence indicates that aprotinin attenuates the systemic inflammatory response associated with cardiopulmonary bypass.

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Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

February 2001

Volume

71

Issue

2

Start / End Page

745 / 754

Location

Netherlands

Related Subject Headings

  • Systemic Inflammatory Response Syndrome
  • Respiratory System
  • Inflammation Mediators
  • Humans
  • Cardiopulmonary Bypass
  • Aprotinin
  • Animals
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences
 

Citation

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Mojcik, C. F., & Levy, J. H. (2001). Aprotinin and the systemic inflammatory response after cardiopulmonary bypass. Ann Thorac Surg, 71(2), 745–754. https://doi.org/10.1016/s0003-4975(00)02218-9
Mojcik, C. F., and J. H. Levy. “Aprotinin and the systemic inflammatory response after cardiopulmonary bypass.Ann Thorac Surg 71, no. 2 (February 2001): 745–54. https://doi.org/10.1016/s0003-4975(00)02218-9.
Mojcik CF, Levy JH. Aprotinin and the systemic inflammatory response after cardiopulmonary bypass. Ann Thorac Surg. 2001 Feb;71(2):745–54.
Mojcik, C. F., and J. H. Levy. “Aprotinin and the systemic inflammatory response after cardiopulmonary bypass.Ann Thorac Surg, vol. 71, no. 2, Feb. 2001, pp. 745–54. Pubmed, doi:10.1016/s0003-4975(00)02218-9.
Mojcik CF, Levy JH. Aprotinin and the systemic inflammatory response after cardiopulmonary bypass. Ann Thorac Surg. 2001 Feb;71(2):745–754.
Journal cover image

Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

February 2001

Volume

71

Issue

2

Start / End Page

745 / 754

Location

Netherlands

Related Subject Headings

  • Systemic Inflammatory Response Syndrome
  • Respiratory System
  • Inflammation Mediators
  • Humans
  • Cardiopulmonary Bypass
  • Aprotinin
  • Animals
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences