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The Annals of Thoracic Surgery, Vol 54, 1031-1036, Copyright © 1992 by The Society of Thoracic Surgeons
DM Cosgrove 3d, B Heric, BW Lytle, PC Taylor, R Novoa, LA Golding, RW Stewart, PM McCarthy and FD Loop
We tested the efficacy and safety of aprotinin in 169 patients undergoing
isolated reoperative myocardial revascularization. Patients were randomly
assigned to high-dose aprotinin, low-dose aprotinin, or placebo treatment
groups in a double-blind, placebo-controlled study. Treatment groups did
not differ significantly with respect to age, sex, red cell mass, number of
grafts, use of internal thoracic artery, or incidence of preoperative
aspirin therapy. Patients treated with aprotinin had a significant
reduction in postoperative chest tube drainage (720 +/- 753, 866 +/- 1,636,
and 1,121 +/- 683 mL, respectively, for high-dose aprotinin, low-dose
aprotinin, and placebo; p < 0.001). Transfusion requirements were
reduced in aprotinin-treated patients (2.1 +/- 4.2, 4.8 +/- 11.8, and 4.1
+/- 6.2 units for high- dose, low-dose, and placebo, respectively; p <
0.001). A similar reduction in chest tube drainage and transfusion
requirements was seen in patients using aspirin preoperatively. Q-wave
myocardial infarctions were increased in the aprotinin subgroups (17.5%,
14.3%, and 8.9% for high-dose, low-dose, and placebo groups; not
significant). Acute vein graft thrombosis was found in six of 12 vein
grafts studied at postmortem examination in patients receiving aprotinin
but not in any of five grafts in patients receiving placebo. We conclude
that aprotinin is extremely effective in reducing bleeding and transfusion
requirements and may increase the risk of graft thrombosis.
ARTICLES
Aprotinin therapy for reoperative myocardial revascularization: a placebo-controlled study
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195.
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J. M. Murkin, J. Maurer, and S. Niemcryk Full dose aprotinin administration is associated with a significant decrease in perioperative stroke in patients undergoing elective cardiac surgery: a meta-analysis Ann. Thorac. Surg., January 1, 2002; 73(1): S374 - 374. [Full Text] [PDF]
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S. Beholz, J. Liu, R. Thoelke, C Spiess, and W. Konertz Use of desmopressin and erythropoietin in an anaemic Jehovah's Witness patient with severely impaired coagulation capacity undergoing stentless aortic valve replacement Perfusion, December 1, 2001; 16(6): 485 - 489. [Abstract] [PDF]
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R. C. Landis, D. O. Haskard, and K. M. Taylor New antiinflammatory and platelet-preserving effects of aprotinin Ann. Thorac. Surg., November 1, 2001; 72(5): S1808 - 1813. [Abstract] [Full Text] [PDF]
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G. J. Despotis, M. S. Avidan, and C. W. Hogue Jr Mechanisms and attenuation of hemostatic activation during extracorporeal circulation Ann. Thorac. Surg., November 1, 2001; 72(5): S1821 - 1831. [Abstract] [Full Text] [PDF]
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J. M. Murkin Attenuation of neurologic injury during cardiac surgery Ann. Thorac. Surg., November 1, 2001; 72(5): S1838 - 1844. [Abstract] [Full Text] [PDF]
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C. T. Mora Mangano, M. J. Neville, P. H. Hsu, I. Mignea, J. King, and D. C. Miller Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest Circulation, September 18, 2001; 104(90001): I-276 - 281. [Abstract] [Full Text] [PDF]
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K. Kottke-Marchant and S. Sapatnekar Hemostatic Abnormalities in Cardiopulmonary Bypass: Pathophysiologic and Transfusion Considerations Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 187 - 206. [Abstract] [PDF]
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S. Ulker, M. G. Cinar, U. Bayraktutan, and A. Evinc Aprotinin impairs endothelium-dependent relaxation in rat aorta and inhibits nitric oxide release from rat coronary endothelial cells Cardiovasc Res, June 1, 2001; 50(3): 589 - 596. [Abstract] [Full Text] [PDF]
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M. A. Ruel, F. Wang, M. E. Bourke, J.-Y. Dupuis, J. A. Robblee, W. J. Keon, and F. D. Rubens Is tranexamic acid safe in patients undergoing coronary endarterectomy? Ann. Thorac. Surg., May 1, 2001; 71(5): 1508 - 1511. [Abstract] [Full Text] [PDF]
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J. P. Gott Leukodepletion and aprotinin improve clinical outcome after extracorporeal circulation Perfusion, January 1, 2001; 16(1_suppl): 5 - 9. [Abstract] [PDF]
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M. De Bonis, F. Cavaliere, F. Alessandrini, E. Lapenna, F. Santarelli, U. Moscato, R. Schiavello, and G. F. Possati TOPICAL USE OF TRANEXAMIC ACID IN CORONARY ARTERY BYPASS OPERATIONS: A DOUBLE-BLIND, PROSPECTIVE, RANDOMIZED, PLACEBO-CONTROLLED STUDY J. Thorac. Cardiovasc. Surg., March 1, 2000; 119(3): 575 - 580. [Abstract] [Full Text] [PDF]
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S. V Moran, G. Lema, J. Medel, M. J Irarrazaval, R. Zalaquett, B. Garayar, and R. Flaskamp Comparison of two doses of aprotinin in patients receiving aspirin before coronary bypass surgery Perfusion, March 1, 2000; 15(2): 105 - 110. [Abstract] [PDF]
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F. Forestier, S. Belisle, D. Robitaille, R. Martineau, L. P. Perrault, and J.-F. Hardy Low-dose aprotinin is ineffective to treat excessive bleeding after cardiopulmonary bypass Ann. Thorac. Surg., February 1, 2000; 69(2): 452 - 456. [Abstract] [Full Text] [PDF]
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B. P. Bidstrup, B. J. Hunt, S. Sheikh, R. N. Parratt, J. M. Bidstrup, and R. N. Sapsford Amelioration of the bleeding tendency of preoperative aspirin after aortocoronary bypass grafting Ann. Thorac. Surg., February 1, 2000; 69(2): 541 - 547. [Abstract] [Full Text] [PDF]
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M. Klein, P.R. Keith, H.-P. Dauben, H.D. Schulte, H. Beckmann, G. Mayer, O. Elert, and E. Gams Aprotinin counterbalances an increased risk of peri-operative haemorrhage in CABG patients pre-treated with Aspirin Eur. J. Cardiothorac. Surg., October 1, 1999; 14(4): 360 - 366. [Abstract] [Full Text] [PDF]
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C. Lentschener, P. Cottin, H. Bouaziz, F. J. Mercier, M. Wolf, Y. Aljabi, C. Boyer-Neumann, and D. Benhamou Reduction of Blood Loss and Transfusion Requirement by Aprotinin in Posterior Lumbar Spine Fusion Anesth. Analg., September 1, 1999; 89(3): 590 - 590. [Abstract] [Full Text] [PDF]
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M. M.H. Khan, N. Gikakis, S. Miyamoto, A. K. Rao, S. L. Cooper, L. H. Edmunds Jr, and R. W. Colman Aprotinin inhibits thrombin formation and monocyte tissue factor in simulated cardiopulmonary bypass Ann. Thorac. Surg., August 1, 1999; 68(2): 473 - 478. [Abstract] [Full Text] [PDF]
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C. R. Smith and T. B. Spanier Aprotinin in deep hypothermic circulatory arrest Ann. Thorac. Surg., July 1, 1999; 68(1): 278 - 286. [Abstract] [Full Text] [PDF]
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T. Miyashita, Y. Hayashi, Y. Ohnishi, and M. Kuro Retrospective analysis of effect of low-dose aprotinin priming on allogeneic blood transfusion in repeated cardiac operations Perfusion, May 1, 1999; 14(3): 189 - 194. [Abstract] [PDF]
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J. J. Munoz, N. J. O. Birkmeyer, J. D. Birkmeyer, G. T. O'Connor, and L. J. Dacey Is {epsilon}-Aminocaproic Acid as Effective as Aprotinin in Reducing Bleeding With Cardiac Surgery? : A Meta-Analysis Circulation, January 12, 1999; 99(1): 81 - 89. [Abstract] [Full Text] [PDF]
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J. A. Hyde, J. A Chinn, and T. R Graham Platelets and cardiopulmonary bypass Perfusion, December 1, 1998; 13(6): 389 - 407. [PDF]
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