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Ann Thorac Surg 2008;86:355. doi:10.1016/j.athoracsur.2008.02.068
© 2008 The Society of Thoracic Surgeons
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David Rice
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Correspondence

Reply

Faisal G. Bakaeen, MD, David Rice, MD

Division of Thoracic Surgery, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030

(Email: fbakaeen{at}bcm.tmc.edu).

To the Editor:

We thank West and Prakash [1] for their informative letter.

In their experience, aprotinin use in extrapleural pneumonectomy (EPP) did not result in a statistically significant reduction in blood loss. This finding is similar to ours [2], but interestingly, the amount of intraoperative blood loss reported in their patient population was double that reported by our group. Furthermore, West and Prakash [1] used a full-dose aprotinin regimen in contrast to our half-dose regimen.

We had to prematurely close our prospective studies of aprotinin use in EPP and esophagectomy because of a recent advisory from the drug manufacturer recommending that cardiopulmonary bypass be immediately available when administering aprotinin. This was prompted by concerns regarding rare anaphylactic reactions in patients receiving aprotinin.

In view of the current controversy and safety concerns, we have suspended the use of aprotinin in all general thoracic procedures including EPP. However, we believe that the final verdict on the future use of aprotinin is pending on the release of further information from ongoing investigations.


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 References
 

  1. West D, Prakash D. Aprotinin and extrapleural pneumonectomy(letter) Ann Thorac Surg 2008;86:354-355.[Free Full Text]
  2. Bakaeen FG, Rice D, Correa AM, et al. Use of aprotinin in extrapleural pneumonectomy: effect on hemostasis and incidence of complications Ann Thorac Surg 2007;84:982-987.[Abstract/Free Full Text]




This Article
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Faisal G. Bakaeen
David Rice
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