Enoxaparin suppresses thrombin formation and activity during cardiopulmonary bypass in baboons.
Enoxaparin suppresses thrombin formation and activity during cardiopulmonary bypass in baboons.
复制标题
依诺肝素抑制狒狒体外循环期间凝血酶的形成和活性。
DOI：
10.1016/s0022-5223(98)70057-1
复制
发表时间：
1998
期刊：
影响因子：
--
通讯作者：
EdmundsJr,LH
中科院分区：
文献类型：
--
作者：
Gikakis,N;Rao,AK;Miyamoto,S;Gorman3rd,JH;Khan,MM;Anderson,HL;Hack,CE;Sun,L;Niewiarowski,S;Colman,RW;EdmundsJr,LH
目的本研究验证了依诺肝素（一种低分子量肝素和强效Xa因子抑制剂）单独或与标准肝素联合抑制狒狒体外循环过程中凝血酶的形成和活性，调节补体激活和中性粒细胞弹性酶释放的假设。方法在初步研究了抗凝血剂和鱼精蛋白的剂量和可能的种类差异后，27只麻醉狒狒使用标准的、未分离的猪肠肝素、依诺肝素或肝素和依诺肝素的联合进行常温体外循环。适当剂量的鱼精蛋白用于抗凝逆转。在6个时间点采集血样。监测活化凝血时间；在体外循环术前和术后24小时内测量模板出血次数。结果抗凝剂对血流动力学指标无影响。在整个旁路过程中，活化凝血时间保持在400秒以上，未观察到血栓。抗凝剂不改变血小板计数、二磷酸腺苷聚集、β-血小板球蛋白释放、中性粒细胞弹性酶释放或补体C3b/c和C4b/c。单独使用依诺肝素，而不是联合使用，可显著降低凝血酶原片段F1.2、纤维蛋白肽A和凝血酶-抗凝血酶复合物的血浆水平，但延长模板出血时间超过24小时。结论依诺肝素可显著降低体外循环过程中凝血酶的形成和活性，但对补体活化和中性粒细胞弹性酶释放无抑制作用，体外循环后鱼精蛋白对凝血酶的逆转作用不明显。[J]; journal of nurses training; 2009; 16(3): 391 - 391。
ObjectiveThis study tests the hypotheses that enoxaparin, a low molecular weight heparin and potent inhibitor of factor Xa, alone or in combination with standard heparin, inhibits thrombin formation and activity and modulates complement activation and neutrophil elastase release during cardiopulmonary bypass in baboons.MethodsAfter preliminary studies to determine doses and possible species differences to anticoagulants and protamine, 27 anesthesized baboons had normothermic cardiopulmonary bypass with standard, unfractionated, porcine intestinal heparin, enoxaparin, or a combination of heparin and enoxaparin. Protamine in appropriate doses was used to reverse anticoagulation. Blood samples were obtained at 6 time points. Activated clotting times were monitored; template bleeding times were measured before and up to 24 hours after cardiopulmonary bypass.ResultsHemodynamic measurements were not affected by the anticoagulant. Activated clotting times remained above 400 seconds throughout bypass, and no clots were observed. The anticoagulant did not alter platelet count, aggregation to adenosine diphosphate, release of β-thromboglobulin, release of neutrophil elastase, or complement C3b/c and C4b/c. Enoxaparin alone, but not in combination, significantly reduced plasma levels of prothrombin fragment F1.2, fibrinopeptide A, and thrombin-antithrombin complexes but prolonged template bleeding times for more than 24 hours.ConclusionEnoxaparin significantly reduces thrombin formation and activity during cardiopulmonary bypass but does not suppress complement activation and neutrophil elastase release and is not adequately reversed by protamine after bypass. (J Thorac Cardiovasc Surg 1998;116:1043-51)