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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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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, G. Asimakopoulos, M. Poullis, D. O. Haskard, and K. M. Taylor The antithrombotic and antiinflammatory mechanisms of action of aprotinin Ann. Thorac. Surg., December 1, 2001; 72(6): 2169 - 2175. [Abstract] [Full Text] [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 (2009): I-276 - I-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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J. B. Rich The efficacy and safety of aprotinin use in cardiac surgery Ann. Thorac. Surg., November 1, 1998; 66(90050): S6 - 11. [Abstract] [Full Text] [PDF]
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J. P. Gott, W. A. Cooper, F. E. Schmidt Jr, W. M. Brown III, C. E. Wright, J. D. Merlino, J. D. Fortenberry, W. S. Clark, and R. A. Guyton Modifying risk for extracorporeal circulation: trial of four antiinflammatory strategies Ann. Thorac. Surg., September 1, 1998; 66(3): 747 - 754. [Abstract] [Full Text] [PDF]
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P. M. Mannucci Hemostatic Drugs N. Engl. J. Med., July 23, 1998; 339(4): 245 - 253. [Full Text] [PDF]
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W. Dietrich Incidence of Hypersensitivity Reactions Ann. Thorac. Surg., June 1, 1998; 65(90060): S60 - 64. [Abstract] [Full Text] [PDF]
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G. Cohen, J. Ivanov, R. D. Weisel, V. Rao, M. K. Mohabeer, and D. A. G. Mickle Aprotinin and Dipyridamole for the Safe Reduction of Postoperative Blood Loss Ann. Thorac. Surg., March 1, 1998; 65(3): 674 - 683. [Abstract] [Full Text] [PDF]
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J. M. Alvarez, J. Goldstein, J. Mezzatesta, B. Flanagan, and M. Dodd Fatal intraoperative pulmonary thrombosis after graft replacement ofan aneurysm of the arch and descending aorta in association with deephypothermic circulatory arrest and aprotinin therapy J. Thorac. Cardiovasc. Surg., March 1, 1998; 115(3): 723 - 724. [Full Text] [PDF]
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 R. Pifarre Use of Aprotinin in the Control of Bleeding During Cardiopulmonary Bypass Surgery: Current Status Clinical and Applied Thrombosis/Hemostasis, January 1, 1998; 4(1): 2 - 6. [Abstract] [PDF]
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W. Dietrich, K. Schopf, M. Spannagl, M. Jochum, S. L. Braun, and H. Meisner Influence of High- and Low-Dose Aprotinin on Activation of Hemostasis in Open Heart Operations Ann. Thorac. Surg., January 1, 1998; 65(1): 70 - 77. [Abstract] [Full Text] [PDF]
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B. P. Bidstrup Coronary Artery Bypass Graft Patency Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1997; 1(4): 282 - 287. [Abstract] [PDF]
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S. Westaby Aprotinin Fifteen Years Later Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1997; 1(4): 366 - 375. [Abstract] [PDF]
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D. Royston Hemostatic Drugs in Prothrombotic or Hypercoagulable States Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1997; 1(4): 376 - 394. [Abstract] [PDF]
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N. Hayashida, T. Isomura, T. Sato, H. Maruyama, K. Kosuga, and S. Aoyagi EFFECTS OF MINIMAL-DOSE APROTININ ON CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., August 1, 1997; 114(2): 261 - 269. [Abstract] [Full Text]
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 R. R. Lazzara, F. E. Kidwell, M. F. Kraemer, J. A. Wood, and A. Starr Reduction in Costs, Blood Products, and Operating Time in Patients Undergoing Open Heart Surgery Arch Surg, August 1, 1997; 132(8): 858 - 861. [Abstract] [PDF]
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S. Allen, N. Anastasiou, D. Royston, R. Paniagua, and M. Yacoub EFFECT OF APROTININ ON VASCULAR REACTIVITY OF CORONARY BYPASS GRAFTS J. Thorac. Cardiovasc. Surg., February 1, 1997; 113(2): 319 - 326. [Abstract] [Full Text]
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S. Ashraf, Y. Tian, D. Cowan, U. Nair, R. Chatrath, N. R. Saunders, K. G. Watterson, and P. G. Martin ""Low-Dose"" Aprotinin Modifies Hemostasis but Not Proinflammatory Cytokine Release Ann. Thorac. Surg., January 1, 1997; 63(1): 68 - 73. [Abstract] [Full Text]
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W. Dietrich, P. Spath, A. Ebell, and J. A. Richter PREVALENCE OF ANAPHYLACTIC REACTIONS TO APROTININ: ANALYSIS OF TWO HUNDRED FORTY-EIGHT REEXPOSURES TO APROTININ IN HEART OPERATIONS J. Thorac. Cardiovasc. Surg., January 1, 1997; 113(1): 194 - 201. [Abstract] [Full Text]
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P. K. Smith and L. H. Muhlbaier Aprotinin: Safe and Effective Only With the Full-Dose Regimen Ann. Thorac. Surg., December 1, 1996; 62(6): 1575 - 1577. [Full Text]
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J. H. Lemmer Jr, E. W. Dilling, J. R. Morton, J. B. Rich, F. Robicsek, D. L. Bricker, C. B. Hantler, J. G. Copeland III, J. L. Ochsner, P. O. Daily, et al. Aprotinin for Primary Coronary Artery Bypass Grafting: A Multicenter Trial of Three Dose Regimens Ann. Thorac. Surg., December 1, 1996; 62(6): 1659 - 1668. [Abstract] [Full Text]
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S. Cicek, U. Demirkilic, E. Ozal, E. Kuralay, H. Bingol, H. Tatar, and O. Y. Ozturk POSTOPERATIVE USE OF APROTININ IN CARDIAC OPERATIONS: AN ALTERNATIVE TO ITS PROPHYLACTIC USE J. Thorac. Cardiovasc. Surg., December 1, 1996; 112(6): 1462 - 1467. [Abstract] [Full Text]
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J. S. Tweddell, S. Berger, P. C. Frommelt, A. N. Pelech, D. A. Lewis, R. T. Fedderly, M. A. Frommelt, T. S. McManus, Ccp, K. A. Mussatto, et al. Aprotinin Improves Outcome of Single-Ventricle Palliation Ann. Thorac. Surg., November 1, 1996; 62(5): 1329 - 1335. [Abstract] [Full Text]
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J. T. Christenson, J. Reuse, P. Badel, F. Simonet, and M. Schmuziger Plateletpheresis Before Redo CABG Diminishes Excessive Blood Transfusion Ann. Thorac. Surg., November 1, 1996; 62(5): 1373 - 1378. [Abstract] [Full Text]
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M. N. D'Ambra, C. W. Akins, E. H. Blackstone, S. L. Bonney, L. H. Cohn, D. M. Cosgrove, J. H. Levy, K. E. Lynch, and R. Maddi APROTININ IN PRIMARY VALVE REPLACEMENT AND RECONSTRUCTION: A MULTICENTER, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL J. Thorac. Cardiovasc. Surg., October 1, 1996; 112(4): 1081 - 1089. [Abstract] [Full Text]
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M. R. Terrell, J. M. Walenga, M. J. Koza, and R. Pifarre Efficacy of Aprotinin With Various Anticoagulant Agents in Cardiopulmonary Bypass Ann. Thorac. Surg., August 1, 1996; 62(2): 506 - 511. [Abstract] [Full Text]
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R. G. H. Speekenbrink, C. R. H. Wildevuur, A. Sturk, and L. Eijsman LOW-DOSE AND HIGH-DOSE APROTININ IMPROVE HEMOSTASIS IN CORONARY OPERATIONS J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 523 - 530. [Abstract] [Full Text]
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S. Cicek, U. Demirkilic, E. Kuralay, E. Ozal, and H. Tatar Postoperative Aprotinin: Effect on Blood Loss and Transfusion Requirements in Cardiac Operations Ann. Thorac. Surg., May 1, 1996; 61(5): 1372 - 1376. [Abstract] [Full Text]
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D. Katsaros, M. Petricevic, N. J. Snow, D. D. Woodhall, and R. Van Bergen Tranexamic Acid Reduces Postbypass Blood Use: A Double-Blinded, Prospective, Randomized Study of 210 Patients Ann. Thorac. Surg., April 1, 1996; 61(4): 1131 - 1135. [Abstract] [Full Text]
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G. J. Despotis, A. L. Alsoufiev, E. Spitznagel, L. T. Goodnough, and D. G. Lappas Response of Kaolin ACT to Heparin: Evaluation With an Automated Assay and Higher Heparin Doses Ann. Thorac. Surg., March 1, 1996; 61(3): 795 - 799. [Abstract] [Full Text]
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F. Rubens, P. Wells, J. A. Rousou, R. M. Engelman, J. E. Flack III, D. W. Deaton, and S. G. Owen Tranexamic Acid Use During Coronary Artery Bypass Grafting Ann. Thorac. Surg., February 1, 1996; 61(2): 774 - 775. [Full Text]
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D. J. Goldstein, C. M. DeRosa, L. B. Mongero, A. D. Weinberg, R. E. Michler, E. A. Rose, M. C. Oz, and C. R. Smith SAFETY AND EFFICACY OF APROTININ UNDER CONDITIONS OF DEEP HYPOTHERMIA AND CIRCULATORY ARREST J. Thorac. Cardiovasc. Surg., December 1, 1995; 110(6): 1615 - 1622. [Abstract] [Full Text]
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U. Niederhauser, P. Vogt, J. Schneider, E. R. Schmid, M. Tornic, C. Gasser, E. Oechslin, and M. I.Turina FATAL PULMONARY HYPERTENSION AFTER HEART TRANSPLANTATION: SEQUELAE OF POSTACTINIC PULMONARY VASCULAR CHANGES J. Thorac. Cardiovasc. Surg., November 1, 1995; 110(5): 1565 - 1566. [Full Text]
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J. H. Levy, R. Pifarre, H. V. Schaff, J. C. Horrow, R. Albus, B. Spiess, T. K. Rosengart, J. Murray, R. E. Clark, P. Smith, et al. A Multicenter, Double-Blind, Placebo-Controlled Trial of Aprotinin for Reducing Blood Loss and the Requirement for Donor-Blood Transfusion in Patients Undergoing Repeat Coronary Artery Bypass Grafting Circulation, October 15, 1995; 92(8): 2236 - 2244. [Abstract] [Full Text]
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D. Green, J. Sanders, M. Eiken, C. A. Wong, J. Frederiksen, A. Joob, A. Palmer, A. Trowbridge, B. Woodruff, M. Moerch, et al. RECOMBINANT APROTININ IN CORONARY ARTERY BYPASS GRAFT OPERATIONS J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 963 - 970. [Abstract] [Full Text]
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P. R. Feindt, S. Walcher, I. Volkmer, H. E. Keller, U. Straub, H. Huwer, U. T. Seyfert, T. Petzold, and E. Gams Effects of High-Dose Aprotinin on Renal Function in Aortocoronary Bypass Grafting Ann. Thorac. Surg., October 1, 1995; 60(4): 1076 - 1080. [Abstract] [Full Text]
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A. Wahba, A. Philip, M. Bauer, M. Kaiser, H. Aebert, and D. Birnbaum The blood saving potential of vortex versus roller pump with and without aprotinin Perfusion, September 1, 1995; 10(5): 333 - 341. [Abstract] [PDF]
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E. A. Bukhari, I. B. Krukenkamp, P. G. Burns, G. R. Gaudette, J. J. Schulman, M. R. Al-Fagih, and S. Levitsky Does Aprotinin Increase the Myocardial Damage in the Setting of Ischemia and Preconditioning? Ann. Thorac. Surg., August 1, 1995; 60(2): 307 - 310. [Abstract] [Full Text]
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L. T. Goodnough, G. J. Despotis, C. W. Hogue Jr, and T. B. Ferguson Jr On the Need for Improved Transfusion Indicators in Cardiac Surgery Ann. Thorac. Surg., August 1, 1995; 60(2): 473 - 480. [Abstract] [Full Text]
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R. Pifarre State-of-the-Art Review: Optimal Anticoagulation in Cardiovascular Surgery Clinical and Applied Thrombosis/Hemostasis, June 1, 1995; 1(3): 173 - 178. [Abstract] [PDF]
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