Prostacyclin eliminates the thrombocytopenia associated with charcoal hemoperfusion and minimizes heparin and fibrinogen consumption.

To evaluate the effects of prostacyclin (PGI2) on the bioincompatibility of charcoal hemoperfusion (CHP), platelet counts, platelet aggregate formation as measured by screen filtration pressure (SFP), plasma fibrinogen levels, and heparin activity monitored by calcium-thrombin clotting times (Ca-TCT) were compared during CHP in healthy dogs with heparin alone or heparin plus PGI2. Platelet losses (25 +/- 6 vs 83 +/- 2%: mean +/- SEM), rise in SFP (65 +/- 6 vs 249 +/- 25 mmHg), and fibrinogen consumption (20 +/- 5 vs 46 +/- 6%) were significantly less during CHP with PGI2 than with heparin only. In addition, rapid neutralization of heparin, as monitored by Ca-TCT, during CHP was prevented by PGI2. The use of PGI2 may allow a proper evaluation of the efficacy of CHP in conditions such as fulminant hepatic failure where, hitherto, incompatibility between blood and charcoal may have had deleterious effects.