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document
Combined administration of nitric oxide gas and iloprost during cardiopulmonary bypass reduces platelet dysfunction : a pilot clinical study . BACKGROUND Thrombocytopenia and platelet dysfunction are major mechanisms of cardiopulmonary bypass-induced postoperative hemorrhage . This study evaluated the effects of low amounts of nitric oxide , iloprost ( prostacyclin analog ) , and their combination administered directly into the oxygenator on platelet function , platelet-leukocyte interactions , and postoperative blood loss in patients undergoing coronary artery bypass grafting . METHODS Blood samples from 41 patients randomized to the control , nitric oxide ( 20 ppm ) , iloprost ( 2 ng x kg -1 x min -1 ) , or nitric oxide plus iloprost groups were collected during cardiopulmonary bypass . Platelets and leukocytes were enumerated . Platelet membrane glycoprotein Ib and glycoprotein IIb/IIIa , P-selectin , platelet-derived microparticles , leukocyte CD11b/CD18 ( Mac-1 ) , and platelet-leukocyte aggregate were quantified by means of flow cytometry . Collagen and thrombin receptor-activating peptide-induced platelet aggregation in whole blood was analyzed by means of aggregometry . RESULTS Both nitric oxide or iloprost attenuated cardiopulmonary bypass-induced thrombocytopenia , reduction of glycoprotein Ib and glycoprotein IIb levels , translocation of P-selectin , microparticle formation , Mac-1 upregulation , and suppression of collagen-induced aggregation . Nitric oxide plus iloprost was significantly more effective in preventing thrombocytopenia , microparticle formation , and P-selectin translocation . Moreover , this treatment preserved thrombin receptor-activating peptide-induced aggregation , which was not rescued by single treatments . Both nitric oxide and nitric oxide plus iloprost attenuated postoperative blood loss . CONCLUSIONS Nitric oxide plus iloprost reduced the deleterious effects of cardiopulmonary bypass , such as thrombocytopenia , platelet activation , platelet-leukocyte aggregate formation , and suppression of platelet aggregative responses . The reduced postoperative bleeding observed with this treatment suggests that this is a new and clinically feasible therapeutic option for patients subjected to cardiopulmonary bypass .
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Intervention_Pharmacological
nitric oxide gas and iloprost
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Intervention_Pharmacological
nitric oxide , iloprost ( prostacyclin analog )
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Intervention_Pharmacological
nitric oxide
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Intervention_Pharmacological
iloprost
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Intervention_Pharmacological
nitric oxide plus iloprost
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Outcome_Physical
Platelet membrane glycoprotein Ib
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Outcome_Physical
glycoprotein IIb/IIIa , P-selectin , platelet-derived microparticles , leukocyte CD11b/CD18 ( Mac-1 )
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Outcome_Physical
platelet-leukocyte aggregate
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Outcome_Physical
thrombocytopenia
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Outcome_Physical
glycoprotein Ib
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Outcome_Physical
glycoprotein IIb levels
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Outcome_Physical
P-selectin
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Outcome_Physical
Mac-1 upregulation
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Outcome_Physical
collagen-induced aggregation .
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Outcome_Physical
thrombocytopenia
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Outcome_Physical
microparticle formation
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Outcome_Physical
P-selectin translocation
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Outcome_Physical
blood loss .
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Outcome_Physical
thrombocytopenia
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Outcome_Physical
platelet activation
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Outcome_Physical
platelet-leukocyte aggregate formation
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Outcome_Physical
platelet aggregative responses
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Participant_Condition
cardiopulmonary bypass
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Participant_Condition
coronary artery bypass
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Participant_Sample-size
41
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Participant_Condition
cardiopulmonary bypass
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Participant_Condition
cardiopulmonary bypass