ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
John H. Lemmer, Jr
Emery W. Dilling
Jeremy R. Morton
Jeffrey B. Rich
Francis Robicsek
Jack G. Copeland, III
John L. Ochsner
Pat O. Daily
George P. Noon
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lemmer, J. H.
Right arrow Articles by Maddi, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lemmer, J. H., Jr
Right arrow Articles by Maddi, R.
Related Collections
Right arrowRelated Articles

Ann Thorac Surg 1996;62:1659-1668
© 1996 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Aprotinin for Primary Coronary Artery Bypass Grafting: A Multicenter Trial of Three Dose Regimens

John H. Lemmer, Jr, MD, Emery W. Dilling, MD, Jeremy R. Morton, MD, Jeffrey B. Rich, MD, Francis Robicsek, MD, Donald L. Bricker, MD, Charles B. Hantler, MD, Jack G. Copeland, III, MD, John L. Ochsner, MD, Pat O. Daily, MD, Charles W. Whitten, MD, George P. Noon, MD, Rosemarie Maddi, MD

Good Samaritan Hospital, Portland, Oregon; Cardiothoracic and Vascular Surgeons, Austin, Texas; Heart and Lung Surgical Associates, Portland, Maine; Sentara Norfolk General Hospital, Norfolk, Virginia; The Carolinas Heart Institute, Charlotte, North Carolina; Southwestern Cardiovascular Surgical Associates, Lubbock, Texas; University of Texas Health Science Center, San Antonio, Texas; University of Arizona College of Medicine, Tucson, Arizona; Ochsner Clinic, New Orleans, Louisiana; Sharp Memorial Hospital, San Diego, California; University of Texas Southwestern Medical Center, Dallas, Texas; Baylor College of Medicine, Houston, Texas; and Brigham and Women's Hospital, Boston, Massachusetts

Background. High-dose aprotinin reduces transfusion requirements in patients undergoing coronary artery bypass grafting, but the safety and effectiveness of smaller doses is unclear. Furthermore, patient selection criteria for optimal use of the drug are not well defined.

Methods. Seven hundred and four first-time coronary artery bypass grafting patients were randomized to receive one of three doses of aprotinin (high, low, and pump-prime–only) or placebo. The patients were stratified as to risk of excessive bleeding.

Results. All three aprotinin doses were highly effective in reducing bleeding and transfusion requirements. Consistent efficacy was not, however, demonstrated in the subgroup of patients at low risk for bleeding. There were no differences in mortality or the incidences of renal failure, strokes, or definite myocardial infarctions between the groups, although the pump-prime–only dose was associated with a small increase in definite, probable, or possible myocardial infarctions (p = 0.045).

Conclusions. Low-dose and pump-prime–only aprotinin regimens provide reductions in bleeding and transfusion requirements that are similar to those of high-dose regimens. Although safe, aprotinin is not routinely indicated for the first-time coronary artery bypass grafting patient who is at low risk for postoperative bleeding. The pump-prime–only dose is not currently recommended because of a possible association with more frequent myocardial infarctions.


Related Articles

Aprotinin: Safe and Effective Only With the Full-Dose Regimen
Peter K. Smith and Lawrence H. Muhlbaier
Ann. Thorac. Surg. 1996 62: 1575-1577. [Extract] [Full Text]

Discussion
Ann. Thorac. Surg. 1996 62: 1667-1668. [Extract] [Full Text]



This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
S. Westaby
Aprotinin: Twenty-five years of claim and counterclaim
J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 487 - 491.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
M. D. McEvoy, S. T. Reeves, J. G. Reves, and F. G. Spinale
Aprotinin in Cardiac Surgery: A Review of Conventional and Novel Mechanisms of Action
Anesth. Analg., October 1, 2007; 105(4): 949 - 962.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
G. Veres, T. Radovits, H. Schultz, L.-n. Lin, J. Hutter, E. Weigang, Z. Szabolcs, and G. Szabo
Effect of recombinant aprotinin on postoperative blood loss and coronary vascular function in a canine model of cardiopulmonary bypass
Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 340 - 345.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
J. R. Brown, N. J.O. Birkmeyer, and G. T. O'Connor
Meta-Analysis Comparing the Effectiveness and Adverse Outcomes of Antifibrinolytic Agents in Cardiac Surgery
Circulation, June 5, 2007; 115(22): 2801 - 2813.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
P. M. Mannucci and M. Levi
Prevention and Treatment of Major Blood Loss
N. Engl. J. Med., May 31, 2007; 356(22): 2301 - 2311.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al.
Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline
Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
A. Ouattara, H. Bouzguenda, Y. Le Manach, P. Leger, A. Mercadier, P. Leprince, N. Bonnet, G. Montalescot, B. Riou, and P. Coriat
Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin
Eur. Heart J., April 12, 2007; (2007) ehm049v1.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
A. Ronald and J. Dunning
Does use of aprotinin decrease the incidence of stroke and neurological complications in adult patients undergoing cardiac surgery?
Interactive CardioVascular and Thoracic Surgery, December 1, 2006; 5(6): 767 - 773.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
S. C. Body and C. D. Mazer
Pro: Aprotinin Has a Good Efficacy and Safety Profile Relative to Other Alternatives for Prevention of Bleeding in Cardiac Surgery
Anesth. Analg., December 1, 2006; 103(6): 1354 - 1359.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
W. Dietrich, R. Busley, and M. Kriner
High-Dose Aprotinin in Cardiac Surgery: Is High-Dose High Enough?: An Analysis of 8281 Cardiac Surgical Patients Treated with Aprotinin
Anesth. Analg., November 1, 2006; 103(5): 1074 - 1081.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. R. Cooper Jr, J. Abrams, O.H. Frazier, R. Radovancevic, B. Radovancevic, A. W. Bracey, M. J. Kindo, and I. D. Gregoric
Fatal pulmonary microthrombi during surgical therapy for end-stage heart failure: Possible association with antifibrinolytic therapy
J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 963 - 968.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
H. Pleym, A. Wahba, V. Videm, A. Asberg, S. Lydersen, L. Bjella, O. Dale, and R. Stenseth
Increased fibrinolysis and platelet activation in elderly patients undergoing coronary bypass surgery.
Anesth. Analg., March 1, 2006; 102(3): 660 - 667.
[Abstract] [Full Text] [PDF]

Home page
 ASH Education BookHome page
L. L.K. Leung
Perioperative Evaluation of Bleeding Diathesis
Hematology, January 1, 2006; 2006(1): 457 - 461.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovasc. Thorac. Ann.Home page
S. G Raja and G. D Dreyfus
Modulation of Systemic Inflammatory Response after Cardiac Surgery
Asian Cardiovasc Thorac Ann, December 1, 2005; 13(4): 382 - 395.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
T. Vanek, M. Jares, R. Fajt, Z. Straka, K. Jirasek, M. Kolesar, P. Brucek, and M. Maly
Fibrinolytic inhibitors in off-pump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo)
Eur. J. Cardiothorac. Surg., October 1, 2005; 28(4): 563 - 568.
[Abstract] [Full Text] [PDF]

Home page
 Am J Health Syst PharmHome page
T. O. Morgan
Cost, quality, and risk: Measuring and stopping the hidden costs of coronary artery bypass graft surgery
Am. J. Health Syst. Pharm., September 15, 2005; 62(18_Supplement_4): S2 - S5.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. Kher, K. K. Meldrum, K. L. Hile, M. Wang, B. M. Tsai, M. W. Turrentine, J. W. Brown, and D. R. Meldrum
Aprotinin improves kidney function and decreases tubular cell apoptosis and proapoptotic signaling after renal ischemia-reperfusion
J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 662 - 662.
[Abstract] [Full Text] [PDF]

Home page
 Clin TrialsHome page
D. Fergusson, K. C. Glass, B. Hutton, and S. Shapiro
Randomized controlled trials of aprotinin in cardiac surgery: could clinical equipoise have stopped the bleeding?
Clinical Trials, June 1, 2005; 2(3): 218 - 232.
[Abstract] [PDF]

Home page
 Br J AnaesthHome page
A. M. Mahdy and N. R. Webster
Perioperative systemic haemostatic agents
Br. J. Anaesth., December 1, 2004; 93(6): 842 - 858.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. Sedrakyan, T. Treasure, and J. A. Elefteriades
Effect of aprotinin on clinical outcomes in coronary artery bypass graft surgery: A systematic review and meta-analysis of randomized clinical trials
J. Thorac. Cardiovasc. Surg., September 1, 2004; 128(3): 442 - 448.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
P. K. Smith, S. K. Datta, L. H. Muhlbaier, G. Samsa, A. Nadel, and J. Lipscomb
Cost analysis of aprotinin for coronary artery bypass patients: analysis of the randomized trials
Ann. Thorac. Surg., February 1, 2004; 77(2): 635 - 642.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Genoni, R. Tavakoli, C. Hofer, O. Bertel, and M. Turina
Clopidogrel before urgent coronary artery bypass graft
J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 288 - 289.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. D. Grayson, M. Khater, M. Jackson, and M. A. Fox
Valvular heart operation is an independent risk factor for acute renal failure
Ann. Thorac. Surg., June 1, 2003; 75(6): 1829 - 1835.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovasc. Thorac. Ann.Home page
Y. Deng, K. Byth, and H. S Paterson
Age and Left Ventricular Impairment Predict Reopening for Bleeding
Asian Cardiovasc Thorac Ann, June 1, 2003; 11(2): 147 - 152.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. Englberger, B. Kipfer, P. A. Berdat, U. E. Nydegger, and T. P. Carrel
Aprotinin in coronary operation with cardiopulmonary bypass: does "low-dose" aprotinin inhibit the inflammatory response?
Ann. Thorac. Surg., June 1, 2002; 73(6): 1897 - 1904.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. H. Lemmer Jr and G. J. Despotis
Antithrombin III concentrate to treat heparin resistance in patients undergoing cardiac surgery
J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 213 - 217.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
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]

Home page
 Ann. Thorac. Surg.Home page
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]

Home page
 Ann. Thorac. Surg.Home page
J. M. Murkin
Attenuation of neurologic injury during cardiac surgery
Ann. Thorac. Surg., November 1, 2001; 72(5): S1838 - 1844.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. M. Alvarez, L. R. Jackson, C. Chatwin, and J. J. Smolich
Low-dose postoperative aprotinin reduces mediastinal drainage and blood product use in patients undergoing primary coronary artery bypass grafting who are taking aspirin: A prospective, randomized, double-blind, placebo-controlled trial
J. Thorac. Cardiovasc. Surg., September 1, 2001; 122(3): 457 - 463.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. J. Ray, M. M. Hales, L. Brown, M. F. O'Brien, and E. G. Stafford
Postoperatively administered aprotinin or epsilon aminocaproic acid after cardiopulmonary bypass has limited benefit
Ann. Thorac. Surg., August 1, 2001; 72(2): 521 - 526.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. Ascione, S. Williams, C. T. Lloyd, T. Sundaramoorthi, A. A. Pitsis, and G. D. Angelini
Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: A prospective randomized study
J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 689 - 696.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. J. Dignan, D. W. Law, P. W. Seah, C. W. Manganas, D. C. Newman, P. W. Grant, and H. D. Wolfenden
Ultra-low dose aprotinin decreases transfusion requirements and is cost effective in coronary operations
Ann. Thorac. Surg., January 1, 2001; 71(1): 158 - 164.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
R. Ascione, M. Caputo, G. Calori, C. T. Lloyd, M. J. Underwood, and G. D. Angelini
Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery : A Prospective, Randomized Study
Circulation, September 26, 2000; 102(13): 1530 - 1535.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
V. Casati, D. Guzzon, M. Oppizzi, F. Bellotti, A. Franco, C. Gerli, M. Cossolini, G. Torri, G. Calori, S. Benussi, et al.
Tranexamic acid compared with high-dose aprotinin in primary elective heart operations: Effects on perioperative bleeding and allogeneic transfusions
J. Thorac. Cardiovasc. Surg., September 1, 2000; 120(3): 520 - 527.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. Ascione, C. T. Lloyd, M. J. Underwood, A. A. Lotto, A. A. Pitsis, and G. D. Angelini
Inflammatory response after coronary revascularization with or without cardiopulmonary bypass
Ann. Thorac. Surg., April 1, 2000; 69(4): 1198 - 1204.
[Abstract] [Full Text] [PDF]

Home page
 PerfusionHome page
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]

Home page
 Ann. Thorac. Surg.Home page
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]

Home page
 CirculationHome page
P. B. Berger, E. L. Alderman, A. Nadel, and H. V. Schaff
Frequency of Early Occlusion and Stenosis in a Left Internal Mammary Artery to Left Anterior Descending Artery Bypass Graft After Surgery Through a Median Sternotomy on Conventional Bypass : Benchmark for Minimally Invasive Direct Coronary Artery Bypass
Circulation, December 7, 1999; 100(23): 2353 - 2358.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. Ascione, C. T. Lloyd, M. J. Underwood, A. A. Lotto, A. A. Pitsis, and G. D. Angelini
Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized study
Ann. Thorac. Surg., December 1, 1999; 68(6): 2237 - 2242.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
C. J. O’Connor, D. V. Brown, M. Avramov, S. Barnes, H. N. O’Connor, and K. J. Tuman
The Impact of Renal Dysfunction on Aprotinin Pharmacokinetics During Cardiopulmonary Bypass
Anesth. Analg., November 1, 1999; 89(5): 1101 - 1101.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. J. Ray, K. F. Brown, C. A. Burrows, and M. F. O’Brien
Economic evaluation of high-dose and low-dose aprotinin therapy during cardiopulmonary bypass
Ann. Thorac. Surg., September 1, 1999; 68(3): 940 - 945.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
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]

Home page
 Ann. Thorac. Surg.Home page
R. Ascione, C. T. Lloyd, M. J. Underwood, W. J. Gomes, and G. D. Angelini
On-pump versus off-pump coronary revascularization: evaluation of renal function
Ann. Thorac. Surg., August 1, 1999; 68(2): 493 - 498.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. Alonso, C. W. Whitten, and G. E. Hill
Pump prime only aprotinin inhibits cardiopulmonary bypass-induced neutrophil CD11b up-regulation
Ann. Thorac. Surg., February 1, 1999; 67(2): 392 - 395.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
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]

Home page
 Ann. Thorac. Surg.Home page
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]

Home page
 Ann. Thorac. Surg.Home page
M. Misfeld, S. Dubbert, S. Eleftheriadis, H.-J. Siemens, T. Wagner, and H.-H. Sievers
Fibrinolysis-adjusted perioperative low-dose aprotinin reduces blood loss in bypass operations
Ann. Thorac. Surg., September 1, 1998; 66(3): 792 - 799.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
P. M. Mannucci
Hemostatic Drugs
N. Engl. J. Med., July 23, 1998; 339(4): 245 - 253.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
H. Mossinger and W. Dietrich
Activation of Hemostasis During Cardiopulmonary Bypass and Pediatric Aprotinin Dosage
Ann. Thorac. Surg., June 1, 1998; 65(90060): S45 - 51.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
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]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
S. Westaby
Aprotinin Fifteen Years Later
Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1997; 1(4): 366 - 375.
[Abstract] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
D. Royston
Hemostatic Drugs in Prothrombotic or Hypercoagulable States
Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1997; 1(4): 376 - 394.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1996 by The Society of Thoracic Surgeons.