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Preservation of Platelets and Their Function in Prolonged Cardiopulmonary Bypass Using Prostacyclin

The effects of prostacyclin (PGI) with and without heparin were studied in 28 dogs that underwent 2 hours of cardiopulmonary bypass.Five groups were created: group I (six dogs) received heparin, 1.25 mg/kg; group II (six dogs) received lowdose heparin, 0.5 mg/kg, and PGI, ng/kg/min; group III (six dogs) received low-dose heparin alone; group IV (four dogs) received PGI, 500–1000 ng/kg/min; and group V (six dogs) received ibuprofen, 12.5 mg/kg, dipyridamole, 1 mg/kg, PGI2, 20 ng/kg/min, and low-dose heparin. Significant clot deposition occurred in the oxygenators in groups III, IV and V. Platelet counts decreased to a mean of 36.8 ± 5.7% (± SEM) of control in group I, which had normal clinical heparin dose for dogs, but to only 74 ± 7% of control in group II. This improvement was significant (p < 0.005). Platelet aggregation induced by adenosine diphosphate 60 minutes after CPB showed poor aggregation in group I but almost normal aggregation in group II. Protamine was unnecessary in groups that received PGI.PGI, in combination with low-dose heparin provides adequate anticoagulation during cardiopulmonary bypass in dogs, preserves platelet number and function and is associated with minimal postoperative bleeding.