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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 958-967, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
B Blauhut, C Gross, S Necek, JE Doran, P Spath and P Lundsgaard-Hansen
The use of aprotinin to reduce blood loss after cardiopulmonary bypass is
under debate. Concern has been raised about the renal effects of aprotinin.
We administered a mean aprotinin dose of 4.2 x 10(6) kallikrein-inhibiting
units to 13 patients with coronary disease undergoing cardiopulmonary
bypass for 74 +/- 5 minutes (mean +/- standard error of the mean); 13
comparable patients having cardiopulmonary bypass served as control
subjects, and all were studied postoperatively for 24 hours. Aprotinin
reduced postoperative blood loss by 50% (p = 0.0082). Two of the 13
patients who received aprotinin needed one red cell unit each versus a
total of 18 units in eight of 13 control patients (p = 0.0096). Blood
pressure, hemoglobin value and serum protein concentration were higher
after operation in the aprotinin group (p less than 0.05 to p less than
0.01). Platelet counts did not differ, but plasma thromboxane was lower in
aprotinin recipients (p less than 0.001). In control patients fibrinogen
degradation products (D dimer) doubled, and alpha 2-antiplasmin activity
was halved during and after cardiopulmonary bypass (p less than 0.01 to p
less than 0.001), whereas aprotinin patients showed no changes. The
complement breakdown products C4a, C3a, and C3dg as well as C9 neoantigen
increased from prebypass baseline in both groups (p less than 0.001); the
increment of C3a and C3dg was greater in the aprotinin than in the control
patients (p less than 0.001). Serum electrolytes, osmolality, and
creatinine remained normal in both groups of patients. Creatinine clearance
was normal or above normal and virtually identical in both groups. Osmolar
clearance and fractional sodium excretion were higher in the aprotinin
group than in the control group shortly after cardiopulmonary bypass (p
less than 0.05 to p less than 0.01); renal function was unremarkable the
next morning. No adverse clinical effects attributable to aprotinin were
seen. In summary, aprotinin offers advantages for cardiopulmonary bypass.
ARTICLES
Effects of high-dose aprotinin on blood loss, platelet function, fibrinolysis, complement, and renal function after cardiopulmonary bypass
Department of Anesthesiology, General Hospital, Linz, Austria.
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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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J. A. Magovern, T. Sakert, D. H. Benckart, J. A. Burkholder, G. A. Liebler, G. J. Magovern Sr, and G. J. Magovern Jr A Model for Predicting Transfusion After Coronary Artery Bypass Grafting Ann. Thorac. Surg., January 1, 1996; 61(1): 27 - 32. [Abstract] [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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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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S. F. Khuri, C. R. Valeri, J. Loscalzo, M. J. Weinstein, V. Birjiniuk, N. A. Healey, H. MacGregor, M. Doursounian, and M. A. Zolkewitz Heparin Causes Platelet Dysfunction and Induces Fibrinolysis Before Cardiopulmonary Bypass Ann. Thorac. Surg., October 1, 1995; 60(4): 1008 - 1014. [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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D. J. Goldstein, J. A. Seldomridge, J. M. Chen, K. A. Catanese, C. M. DeRosa, A. D. Weinberg, C. R. Smith, E. A. Rose, H. R. Levin, and M. C. Oz Use of Aprotinin in LVAD Recipients Reduces Blood Loss, Blood Use, and Perioperative Mortality Ann. Thorac. Surg., May 1, 1995; 59(5): 1063 - 1067. [Abstract] [Full Text]
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A. Shinfeld, D. Zippel, J. Lavee, A. Lusky, E. Shinar, N. Savion, and R. Mohr Aprotinin Improves Hemostasis After Cardiopulmonary Bypass Better Than Single-Donor Platelet Concentrate Ann. Thorac. Surg., April 1, 1995; 59(4): 872 - 876. [Abstract] [Full Text]
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I. J Reece, G. H Linley, J. Tolia, J. Sheth, and H. Al Tareif Re-inventing the wheel: the use of autologous and fresh donor blood in cardiac surgery Perfusion, March 1, 1995; 10(2): 93 - 99. [Abstract] [PDF]
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J. A. Rousou, R. M. Engelman, J. E. Flack III, D. W. Deaton, and S. G. Owen Tranexamic Acid Significantly Reduces Blood Loss Associated With Coronary Revascularization Ann. Thorac. Surg., March 1, 1995; 59(3): 671 - 675. [Abstract] [Full Text]
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R. G. H. Speekenbrink, A. B. A. Vonk, C. R. H. Wildevuur, and L. Eijsman Hemostatic Efficacy of Dipyridamole, Tranexamic Acid, and Aprotinin in Coronary Bypass Grafting Ann. Thorac. Surg., February 1, 1995; 59(2): 438 - 442. [Abstract] [Full Text]
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J. H. Lemmer Jr, W. Stanford, S. L. Bonney, E. V. Chomka, R. B. Karp, G. W. Laub, J. A. Rumberger, and H. V. Schaff Aprotinin for Coronary Artery Bypass Grafting: Effect on Postoperative Renal Function Ann. Thorac. Surg., January 1, 1995; 59(1): 132 - 136. [Abstract] [Full Text]
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B. Blauhut, W. Harringer, P. Bettelheim, J. E. Doran, P. Spath, and P. Lundsgaard-Hansen Comparison of the effects of aprotinin and tranexamic acid on blood loss and related variables after cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1083 - 1091. [Abstract] [Full Text]
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P. O. Daily, J. A. Lamphere, W. P. Dembitsky, R. M. Adamson, and N. F. Dans Effect of prophylactic epsilon-aminocaproic acid on blood loss and transfusion requirements in patients undergoing first-time coronary artery bypass graftingA randomized, prospective, double-blind study J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 99 - 108. [Abstract] [Full Text]
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J. Gurevitch, J. Barak, E. Hochhauser, Y. Paz, and V. Yakirevich Aprotinin improves myocardial recovery after ischemia and reperfusion:Effects of the drug on isolated rat hearts J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 109 - 118. [Abstract] [Full Text]
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J. M. Murkin, J. Lux, N. A. Shannon, G. M. Guiraudon, A. H. Menkis, F. N. McKenzie, and R. J. Novick Aprotinin significantly decreases bleeding and transfusion requirements in patients receiving aspirin and undergoing cardiac operations J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 554 - 561. [Abstract] [Full Text]
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M. Ranucci, M. Pavesi, E. Mazza, C. Bertucci, A. Frigiola, L. Menicanti, A. Ditta, A. Boncilli, and D. Conti Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique Perfusion, January 1, 1994; 9(5): 319 - 326. [Abstract] [PDF]
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D. M Cosgrove Use of aprotinin in repeat myocardial revascularization: Cleveland Clinic experience Perfusion, May 1, 1993; 8(1_suppl): 36 - 42. [Abstract] [PDF]
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H. Komai and S. G Haworth The effect of cardiopulmonary bypass on the lung: the injured pulmonary vascular endothelium Perfusion, January 1, 1993; 8(1): 55 - 62. [PDF]
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S. Westaby, A. Parry, and R. Pillai Aortic root replacement: modifications of technique with improvements in technology Eur. J. Cardiothorac. Surg., January 1, 1992; 6(suppl_1): S44 - S49. [Abstract] [PDF]
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