Objective: The effect of aprotinin administration during extracorporeal circulation in pediatric patients is controversial and its mechanism of action is not well known. The objective of this study was to evaluate in children the effect of high doses of aprotinin administered during cardiac surgery with cardiopulmonary bypass on bleeding and on hemostasis.

Methods: 31 patients (age range 1-15 years) undergoing cardiac surgery were included. 17 of them received treatment with aprotinin (240 mg/m2 in bolus followed by 50 mg/m2/h) and 14 were controls. Bleeding was measured during surgery and at 6, 12, and 24 hours post-surgery. Samples to study hemostasis parameters were obtained pre-surgery, after 30 min in cardiopulmonary bypass, at the end of cardiopulmonary bypass and at the end of surgery. Platelet expression of P-selectin and platelet glycoproteins IIb-IIIa and Ib were measured by flow cytometry. Plasmatic content of prothrombin fragment 1+2 (F1+2), plasmin-α2-antiplasmin complexes (PAP), and fibrin-fibrinogen split products (FbFgDP) were quantified by ELISA.

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