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Ann Thorac Surg 1991;51:936-941
© 1991 The Society of Thoracic Surgeons
a Department of Cardiopulmonary Surgery, Research Division, University Hospital, Groningen, the Netherlands
b Department of Hematology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
c Department of Cardiopulmonary Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
Accepted for publication January 21, 1991.
* Address reprint requests to Dr Wildevuur, Department of Cardiopulmonary Surgery, Research Division, University Hospital, Oostersingel 59, Postbus 30.001, 9700 RB Groningen, the Netherlands.
To determine whether aprotinin can provide a significant improvement of hemostasis in Cardiopulmonary bypass using a membrane oxygenator, we tested this drug in a prospective, randomized, double-blind, placebo-controlled clinical trial. The subjects were 80 male patients undergoing Cardiopulmonary bypass for coronary artery bypass grafting. Forty patients received aprotinin and 40 patients served as placebo controls. Aprotinin (4 x 106 KIU) was given as a continuous infusion, starting before operation and continuing until after Cardiopulmonary bypass; additionally, 2 x 106 KIU aprotinin was added to the pump prime. Intraoperative and postoperative bleeding, respectively two thirds and one third of the total perioperative blood loss, were both significantly reduced in the aprotinin-treated group (p < 0.01). The total average perioperative blood loss, corrected to a hemoglobin concentration of 7 mmol/L, was 550 mL in the aprotinin-treated patients versus 900 mL in the control patients. This reduction in blood loss, furthermore, significantly decreased the amount of postoperative blood transfusions (p < 0.05) and increased the percentage of patients who did not receive postoperative donor blood from 42% to 68%. Aprotinin increased the activated clotting time significantly during Cardiopulmonary bypass, which led to a reduction in heparin usage. The improved hemostasis during operation, despite the prolonged activated clotting time, might even abolish the need for heparin conversion with protamine at the end of Cardiopulmonary bypass, thus allowing retransfusion through cardiotomy suction to be continued, which saves the blood that is currently lost with vacuum suction.
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