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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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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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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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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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