Aprotinin reduces the antiplatelet effect of clopidogrel.

Abstract

Aprotinin reduces bleeding and transfusion rates in patients undergoing coronary surgery while on clopidogrel. However, safety studies have indicated that aprotinin may have a possible adverse effect related to an increased incidence of thromboembolic events. We therefore studied the adenosinediphosphate (ADP) mediated platelet aggregation before and after administration of aprotinin in patients on clopidogrel. Fifteen clopidogrel-treated patients with acute coronary syndrome undergoing coronary surgery were studied. ADP-mediated platelet aggregation and platelet count ratio (%) were measured before and after a bolus dose [2 x 10(6) kallikrein inhibiting units (KIU)] of aprotinin. Aprotinin induced an increased aggregation in 11 of 15 patients (73%), and a decrease was registered in two patients (13%). The median (25th/75th percentile) ADP-mediated platelet aggregation before and after aprotinin was 84% (76/91) and 94% (86/97, P<0.01). Clopidogrel non-responders with >90% aggregation (n=4) had a median aggregation of 94.5% (91.5/97.5) vs. 82% (73/87, P<0.01) in the responders (n=11). The median increase in platelet aggregation after aprotinin was 8% (5/20) in the responders vs. 0% (-5.25/3, P<0.01) in the non-responders. Aprotinin increased ADP induced platelet aggregation from 84 to 94% in patients on clopidogrel, which corresponds to a median decrease in relative platelet inhibition of >50%.

• Authors: Gabriella Lindvall, Ulrik Sartipy, Staffan Bjessmo, Peter Svenarud, Bo Lindvall, Jan van der Linden
• Journal: Interactive cardiovascular and thoracic surgery (Interact Cardiovasc Thorac Surg) Vol. 9 Issue 2 Pg. 178-81 (Aug 2009) ISSN: 1569-9285 [Electronic] England
• PMID: 19477870 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Hemostatics
• Platelet Aggregation Inhibitors
• Adenosine Diphosphate
• Aprotinin
• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Acute Coronary Syndrome (blood, drug therapy, surgery)
• Adenosine Diphosphate
• Aged
• Aprotinin (adverse effects, therapeutic use)
• Aspirin (therapeutic use)
• Clopidogrel
• Coronary Artery Bypass
• Drug Interactions
• Drug Therapy, Combination
• Female
• Hemostatics (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Platelet Aggregation (drug effects)
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Ticlopidine (adverse effects, analogs & derivatives, therapeutic use)
• Treatment Outcome