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Ann Thorac Surg 2007;84:1150
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Invited commentary

Department of Cardiothoracic Surgery, Columbia Presbyterian Medical Center, Milstein Hospital Bldg 7-435, 177 Fort Washington Ave, New York, NY 10032

(Email: crs2{at}columbia.edu).

Dietrich and colleagues [1] are to be commended for contributing to our knowledge of the anaphylactic risk associated with aprotinin in 12,403 patients. The conclusions are consistent with immunologic concepts governing antibody-mediated reactions to large proteins, and are also consistent with previous publications on the same subject. It is frequently pointed out that many other drugs more commonly used during anesthesia also carry a risk of anaphylaxis. At a frequency of 1% to 2%, these reactions greatly exceed those to aprotinin. The data from this series does provide some support for the authors’ contention that reactions to aprotinin may be less frequent but are much more serious.

The importance of weighing risks against benefits in patients exposed to aprotinin within the previous 6 months is very clear and difficult to overemphasize. As the authors mention, discussion of anaphylaxis at the September 2006 Food and Drug Administration panel on aprotinin produced rewording of the labeling and induced the sponsor to back away from efforts to market the drug for procedures in which salvage with immediate cardiopulmonary bypass is not available, such as joint replacement. It is important to note that the authors have not encountered a severe reaction since 1998, suggesting that awareness of the problem can generate safe practice. It is also worth noting that absence of proof is not proof of absence, and the possibility of undetected prior exposures must be kept in mind.

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1. Dietrich W, Ebell A, Busley R, Boulesteix A-L. Aprotinin and anaphylaxis: analysis of 12,403 exposures to aprotinin in cardiac surgery Ann Thorac Surg 2007;84:1144-1150.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Craig R. Smith Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Smith, C. R. Search for Related Content PubMed PubMed Citation Articles by Smith, C. R. Related Collections Extracorporeal circulation Related Article