| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2003;75:479-483
© 2003 The Society of Thoracic Surgeons
a Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
Accepted for publication September 15, 2002.
* Address reprint requests to Dr Frumento, Columbia University College of Physicians and Surgeons, Department of Anesthesiology (PH5-505), 630 West 168th St, New York, NY 10032-3784, USA
e-mail: rf356{at}columbia.edu
BACKGROUND: Half-dose aprotinin (HDA) appears to be equivalent to full-dose aprotinin (FDA) in its ability to prevent bleeding. However, data regarding the potential effect of aprotinin use and dosage on other outcomes such as the occurrence of perioperative stroke are limited. It has been postulated that the higher level of kallikrein inhibition obtained with FDA dosing may be required for end-organ protection. Therefore, we performed a retrospective study in cardiac surgery patients at high risk for developing stroke to determine the relative effects of FDA and HDA regimens on the incidence of postoperative stroke.
METHODS: Records of 1,524 patients undergoing cardiac surgery over a 15-month period were reviewed. Patients at high risk for stroke were selected if they met all of the following predefined criteria: age greater than 70 years, history of hypertension, history of diabetes mellitus, history of stroke or transient ischemic attack, and presence of aortic atheroma. A validated preoperative stroke risk index was calculated for each patient. Postoperative stroke required confirmation by computed tomography or magnetic resonance imaging. Patients were divided into three groups according to whether they were administered no aprotinin, HAD, or FDA.
RESULTS: A total of 149 patients fulfilled the criteria for being at high risk for stroke. Stroke risk index was very similar (p = 0.56) in the three groups: those who received no aprotinin and served as a control group (124 ± 15, n = 56), those who were given HDA (123 ± 12, n = 67), and those who received FDA (122 ± 11 n = 26). Preoperative and intraoperative characteristics were also similar between the three study groups. Overall, the incidence of stroke was 16% (24/149). The incidence of stroke differed (p < 0.05) among the three groups: no aprotinin 16% (9/56), HDA 22% (15/67), and FDA 0% (0/26).
CONCLUSIONS: In this retrospective study of cardiac surgery patients at high risk for postoperative stroke, the administration of FDA but not HDA was associated with a lower incidence of stroke.
This article has been cited by other articles:
|
|
 |
|
  T. M. Sundt The demise of aprotinin: Our share of the blame. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 729 - 731. [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Hammon Extracorporeal Circulation: Organ Damage Card. Surg. Adult, January 1, 2008; 3(2008): 389 - 414. [Full Text]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 Y. Kadoi Pharmacological Neuroprotection During Cardiac Surgery Asian Cardiovasc Thorac Ann, April 1, 2007; 15(2): 167 - 177. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
D. Royston, J. H. Levy, J. Fitch, W. Dietrich, S. C. Body, J. M. Murkin, B. D. Spiess, and A. Nadel Full-Dose Aprotinin Use in Coronary Artery Bypass Graft Surgery: An Analysis of Perioperative Pharmacotherapy and Patient Outcomes Anesth. Analg., November 1, 2006; 103(5): 1082 - 1088. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Hogue Jr, C. A. Palin, and J. E. Arrowsmith Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth. Analg., July 1, 2006; 103(1): 21 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. S. Day, R. C. Landis, and K. M. Taylor Aprotinin and the protease-activated receptor 1 thrombin receptor: antithrombosis, inflammation, and stroke reduction. Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2006; 10(2): 132 - 142. [Abstract] [PDF]
|
|
|
|
|
|
G. N. Djaiani Aortic arch atheroma: stroke reduction in cardiac surgical patients. Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2006; 10(2): 143 - 157. [Abstract] [PDF]
|
|
|
|
|
|
A. B. Lal, R. Maruthavanan, and N. B. Scott Aortic Valve Repair in a Patient with Congenital Afibrinogenemia Anesth. Analg., December 1, 2005; 101(6): 1628 - 1630. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Khan, C. Bianchi, E. Araujo, P. Voisine, S.-H. Xu, J. Feng, J. Li, and F. W. Sellke Aprotinin Preserves Cellular Junctions and Reduces Myocardial Edema After Regional Ischemia and Cardioplegic Arrest Circulation, August 30, 2005; 112(9_suppl): I-196 - I-201. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Khan, C. Bianchi, P. Voisine, J. Sandmeyer, J. Feng, and F. W. Sellke Aprotinin Inhibits Protease-Dependent Platelet Aggregation and Thrombosis Ann. Thorac. Surg., May 1, 2005; 79(5): 1545 - 1550. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.R.S. Day, P.P. Punjabi, A.M. Randi, D.O. Haskard, R.C. Landis, and K.M. Taylor Clinical Inhibition of the Seven-Transmembrane Thrombin Receptor (PAR1) by Intravenous Aprotinin During Cardiothoracic Surgery Circulation, October 26, 2004; 110(17): 2597 - 2600. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
L. Shore-Lesserson, D. L. Reich, and D. H. Adams Invited commentary Ann. Thorac. Surg., February 1, 2004; 77(2): 642 - 643. [Full Text] [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 |
