Analyses of coronary graft patency after aprotinin use: Results from the international multicenter aprotinin graft patency experience (IMAGE) trial

Alderman, Edwin L.; Levy, Jerrold H.; Rich, Jeffrey B.; Nili, M; Vidne, Bernardo A.; Schaff, Hartzell V.; Uretzky, Gideon; Pettersson, Gösta; Thiis, Jens J.; Hantler, Charles B.; Chaitman, Bernard R.; Nadel, Andrea

doi:10.1016/s0022-5223(98)00431-0

Cited by 232 publications

(132 citation statements)

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“…20,21 However, this drug is associated with several side effects that should be taken into account. 22,23 Aprotinin was administered in about 50% of patients, using the Hammersmith regimen as it appears to be the most effective and also the safer one. 24,25 Hypothermia has been shown to significantly increase postoperative blood loss, probably by impairing platelet function and reducing clotting factor function.…”

Section: The Blood Conservation Programmentioning

confidence: 99%

A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

et al. 2001

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Section: The Blood Conservation Programmentioning

confidence: 99%

A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

et al. 2001

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“…However, this difference was not statistically significant, and it also contradicts the idea that aprotinin may instigate microvascular and macrovascular thrombosis. 3 Though a possible connection between aprotinin and intravascular thrombosis has been observed in many in vivo animal models as well as in sponsor-supported clinical trials, [15][16][17] this correlation was not supported by the results of this study.…”

Section: Discussionmentioning

confidence: 54%

The Effect of Antifibrinolytic Prophylaxis on Postoperative Outcomes in Patients Undergoing Cardiac Operations

Koul

Ferraris

Davenport

et al. 2012

International Surgery

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Antifibrinolytic agents such as aprotinin and epsilon aminocaproic acid limit postoperative bleeding and blood transfusion in patients undergoing cardiac operations using cardiopulmonary bypass (CPB). Recent evidence suggests that these agents have adverse side effects that influence operative mortality and morbidity. We studied postoperative bleeding, transfusion rates, and operative outcomes in our patients in order to assess the efficacy of these agents during cardiac operations requiring CPB. We reviewed records of 520 patients undergoing a variety of cardiac operations between January 2005 and May 2009. We measured multiple variables including pre-operative risk factors, antifibrinolytic agent used, and outcomes of operation, such as measures of bleeding and blood transfusion, as well as serious operative morbidity and mortality. Postoperative bleeding rates varied significantly between patients receiving aprotinin and those receiving aminocaproic acid (P , 0.05). There was an associated 12% decrease in operative site bleeding in aprotinin-treated patients compared with aminocaproic acid. There was no significant difference in the transfusion rates of packed red blood cells between patients receiving aminocaproic acid or aprotinin (P . 0.05), though individuals in the aprotinin group did receive FFP more frequently than patients in the aminocaproic acid group (P , 0.05). There was no significant difference in morbidity and mortality rates between patients in either drug group (P . 0.05). Our study shows that aprotinin is more effective at controlling operative site bleeding than aminocaproic acid. Reduced operative site bleeding did not portend better outcome or differences in transfusion requirements. Aminocaproic acid remains a safe and cost-effective option for antifibrinolytic prophylaxis because of unavailability of aprotinin.Key words: Aprotinin -Aminocaproic acid -Cardiac surgery -Postoperative bleedingChest tube output -Transfusion -Morbidity -Mortality P ostoperative hemorrhage is a common complication of cardiac operations, with over 50% of patients receiving blood product transfusions.1 For several years aprotinin was an antifibrinolytic drug used to decrease postoperative bleeding in patients undergoing cardiac surgery. This drug was removed from the United States market in November 2007 as studies suggested that its use is associated with increased end-organ damage and increased operative mortality rates. 2,3 Since that time, aminocaproic acid has been the most commonly used prophylactic agent for control of postoperative hemorrhage during cardiac operations.Several previous studies have suggested that aprotinin controls bleeding more effectively than other antifibrinolytic agents such as aminocaproic acid, 1,3-5 while others have suggested an equivalent hemostatic effectiveness among these agents.6 Several studies demonstrate reduced transfusion requirements in patients receiving aprotinin either compared with placebo or with other antifibrinolytic agents. 7-11Since a preponderance of evidence...

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“…The use of aprotinin, even in the high doses regimen, has been questioned regarding the increase in thromboembolic complications. In the multicenter study, IMAGE 81 , sponsored by the manufacturer of aprotinin, with 870 patients undergoing primary myocardial revascularization, occlusion of the graft of saphenous vein was greater in the aprotinin group. The incidence of graft occlusion in the aprotinin group was 15.4% and 10.9% in the placebo group (p = 0.03).…”

Section: Discussionmentioning

confidence: 99%

Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

Santos¹,

Splettstosser²,

Warpechowski³

et al. 2007

Rev. Bras. Anestesiol.

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RESUMOSantos ATL, Splettstosser JC, Warpechowski P, Gaidzinski MMPAntifibrinolíticos e Cirurgia Cardíaca com Circulação Extracorpórea. JUSTIFICATIVA E OBJETIVOS:A cirurgia cardíaca é a especialidade cirúrgica que com mais freqüência está associada a sangramento, coagulopatia e necessidade de derivados de sangue. Os agentes farmacológicos aprotinina, ácido epsilon-aminocapróico e ácido tranexâmico são os mais utilizados para auxiliar na hemostasia dos pacientes submetidos à circulação extracorpórea. O objetivo deste trabalho foi apresentar a fisiopatologia do sangramento em cirurgia cardíaca e a atual situação dos antifibrinolíticos quanto à sua eficácia e complicações quando usados nesses procedimentos, dando maior ênfase ao ácido tranexâmico e à aprotinina. CONTEÚDO:São discutidos os mecanismos pelos quais a circulação extracorpórea provoca alteração na hemostasia e de que maneira os antifibrinolíticos agem para diminuir o sangramento e o uso de sangue alogênico em cirurgia cardíaca. É dada ênfase ao problema do tromboembolismo que pode ocorrer com o emprego desses antifibrinolíticos, com revisão da literatura. CONCLUSÃO:A fibrinólise é um dos principais fatores relacionados com o aumento do sangramento em cirurgia cardíaca com circulação extracorpórea. A inibição da fibrinólise, juntamente com a preservação da função plaquetária, é, provavelmente, o mecanismo pelo qual os antifibrinolíticos diminuem o sangramento. O emprego desses fármacos reduz o sangramento em cirurgia cardíaca com circulação extracorpórea num percentual que pode chegar a 50%. Com relação à preocupação com o tromboembolismo, os áci-dos tranexâmico e epsilon-aminocapróico são opções que oferecem maior segurança que a aprotinina.Unitermos: CIRURGIA, Cardíaca: circulação extracorpórea, DRO-GAS, Antifibrinolíticos: aprotinina, ácido epsilon-aminocapróico, áci-do tranexâmico; SANGUE: coagulação. SUMMARYSantos ATL, Splettstosser JC, Warpechowski P, Gaidzinski MMPAntifibrinolytics and Cardiac Surgery with Cardiopulmonary Bypass. BACKGROUND AND OBJECTIVES:Cardiac surgery is the surgical subspecialty most often associated with bleeding, bleeding disorders, and the need of blood products. Agents such as aprotinin, episilon-aminocaproic acid, and tranexamic acid are frequently used to aid the hemostasis of patients undergoing cardiopulmonary bypass. The objective of this report is to present the physiopathology of bleeding during cardiac surgeries and the current role of antifibrinolytics regarding their efficacy and complications when used in those procedures, with emphasis on tranexamic acid and aprotinin. CONTENTS:The mechanisms of changes in hemostasis caused by cardiopulmonary bypass, how antifibrinolytics decrease bleeding, and the use of alogenic blood in cardiac surgery are discussed. A review of the literature emphasizes the thromboembolism secondary to the use of those antifibrinolytics. CONCLUSION:Fibrinolysis is one of the main factors related with increased bleeding during cardiac surgery with cardiopulmonary bypass. Inhibition of fibrinol...

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Analyses of coronary graft patency after aprotinin use: Results from the international multicenter aprotinin graft patency experience (IMAGE) trial

Abstract: In this study, the probability of early vein graft occlusion was increased by aprotinin, but this outcome was promoted by multiple risk factors for graft occlusion.

Cited by 232 publications

References 28 publications

A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

The Effect of Antifibrinolytic Prophylaxis on Postoperative Outcomes in Patients Undergoing Cardiac Operations

Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

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