Comparative Effects of Proteinase Inhibitors, Plasminogen Antiactivators, Heparin and Acetylsalicylic Acid on the Experimental Disseminated Intravascular Coagulation Induced by Thrombin

Hemostatic Drugs in Prothrombotic or Hypercoagulable States

Certain drug therapies, such as heparin, warfarin, and aspirin, are associated with prothrombotic or hypercoagulable states. If these agents that are administered to prevent thrombosis have been associated with its opposite effect, then agents that are specifically given to inhibit bleeding may produce a deleterious hypocoagulable effect. This article evaluates the risks presented by serine protease inhibitors (ie, aprotinin), lysine analog antifibrinolyics (ie, epsilon aminocaproic acid [Amicar, Wyeth-Ayerst, Philadelphia, PA] and tranexamic acid), and desmopressin acetate (DDAVP, Rhone-Poulenc Rorer, Collegeville, PA). It focuses on their mechanisms of action, particularly their effect on microvascular tone and endothelial function, coagulation factors, platelet function, and the fibrinolytic pathway. It discusses their use in the presence of known thrombin production or fibrinogen conversion and whether certain vascular beds are more prone to drug-related thrombosis.

Effects of aprotinin on hemorrhagic complications in ARDS patients during prolonged extracorporeal CO2 removal

The effects of aprotinin, a broad-based proteinase inhibitor, in the management of hemorrhagic complications during prolonged venovenous extracorporeal CO2 removal in patients with adult respiratory distress syndrome are not evaluated. In two patients, aprotinin infusion was added to heparin to treat bleeding, occurring after few days of bypass and responsible for respiratory and hemodynamic deterioration. After aprotinin infusion (loading dose of 2 x 10(6) kIU followed by a continuous infusion of 5 x 10(5) kIU/h) combined with heparin, bleeding vanished until the end of bypass.