The anticoagulant effect of Bromelain: An in vitro study using Thromboelastography
Mazen Toukh, Hisham S Elbatarny, Maha Othman
Objective: Bromelain is a crude extract from the pineapple that has a wide array of pharmacological effects including protein digestion, fibrinolytic and anti-immune inflammatory effects. However, its clinical applications are still very limited. The aim of this study was to investigate the anticoagulant effect of Bromelain on whole blood samples using thromboelastography.
Method: Following several optimization trials, we identified 0.4 U/mL as the minimum concentration of Bromelain that results in modification of a normal TEG tracing. We next studied the effects of this dose on 7 normal and 3 hypercoagulable blood samples. We incubated 0.4U with 1 mL citrated whole blood for 10 minutes at room temperature before the TEG analysis and we compared the TEG traces before and after incubation of Bromelain.
Results: A significant elongation of the R time, reduction of the alpha angle and CI was observed in blood samples incubated with Bromelain compared to native ones. The average values of TEG parameters in normal samples before addition of Bormelain were as follows: R time: 10.6 ± 2.0 minutes, alpha angle: 27.6 ± 8.0, Maximum amplitude: 45.7 ± 3.5 and coagulation index: 0.4± 1.2 compared to 17.2 ± 5.2, 18.8 ± 5.7, 45.0 ± 6.9 and 1.2 ± 2 respectively following incubation with Bromelain. The average values of TEG parameters in the hypercoagulable samples before addition of Bormelain were: R time: 4.3 ± 3.5 minutes, alpha angle: 77.0 ± 7.8, Maximum amplitude: 65.7± 5.7 and coagulation index: 3.2 ± 1.4 compared to 9.6 ± 4.2, 61.6 ± 7.8, 61.2 ± 2.0 and 1.4 ± 0.6 respectively following incubation with Bromelain.
Conclusion: Bromelain 0.4U/mL can reduce coagulability of normal whole blood and results in normalization of TEG tracing of hypercoagulable samples. The findings from this small in vitro study is a proof of principle of the anticoagulant effect of Bromelain and indicates a potential for Bormelain as future anticoagulant drug that may be monitroed using TEG.
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