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J Thorac Cardiovasc Surg 1997;114:261-269
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

EFFECTS OF MINIMAL-DOSE APROTININ ON CORONARY ARTERY BYPASS GRAFTING

Presented at the Sixty-ninth Scientific Sessions of the American Heart Association, New Orleans, La., Nov. 13, 1996.

Received for publication Oct. 21, 1996 Revisions requested Nov. 26, 1996; revisions received Jan. 11, 1997 Accepted for publication Feb. 21, 1997. Address for reprints: Nobuhiko Hayashida, MD, The Second Department of Surgery, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, 830 Japan.

Abstract

Objective: To evaluate the effects of minimal-dose aprotinin in patients undergoing coronary artery bypass grafting, we conducted a prospective randomized study. Methods: A total of 167 patients were randomized to receive no aprotinin treatment (control, n = 57), minimal-dose aprotinin (1.0 x 10⁶ KIU; n = 55), or low-dose aprotinin (2.7 ± 0.5 x 10⁶ KIU; n = 55). Blood loss and transfusion requirements, parameters of clotting and fibrinolysis, renal function, and early graft patency rates were assessed. Results: Postoperative blood loss and transfusion requirements were significantly (p = 0.01) lower in both the minimal-dose and low-dose groups than in the control group. The increase in D-dimer level after cardiopulmonary bypass was significantly (p < 0.05) less marked in the low-dose group than in the control group. The ₂-plasmin inhibitor and plasminogen activator inhibitor–1 levels were significantly (p < 0.05) greater in the minimal-dose and low-dose groups than in the control group after bypass, suggesting the prevention of fibrinolysis by both aprotinin doses. No statistically significant differences in postoperative renal function and early vein graft patency rates were noted (control group, 93.8%; minimal-dose group, 98.5%; low-dose group, 92.3%; p = 0.25). Conclusions: Aprotinin was not associated with a significant increase in the prevalence of renal dysfunction or early vein graft occlusion. Minimal-dose aprotinin inhibited enhanced fibrinolytic activity and reduced blood loss and transfusion requirements after bypass equivalently to low-dose aprotinin. The dose of 1 x 10⁶ KIU added to the pump prime may be acceptably effective in reducing blood loss in patients undergoing primary coronary operations. J Thorac Cardiovasc Surg 1997;114:261-9

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