Anaphylactic Reactions to Aprotinin Reexposure in Cardiac Surgery

Dietrich, Wulf; Späth, P.; Zühlsdorf, M.; Dalichau, H.; Kirchhoff, P. G.; Kuppe, Hermann; Preiss, D. U.; Mayer, Gabriele

doi:10.1097/00000542-200107000-00015

Cited by 94 publications

(12 citation statements)

References 25 publications

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“…25 Anaphylaxis upon reexposure in cardiac patients was confirmed in 2.5% of patient's. 31 In the two previous studies with aprotinin and in our study there were no anaphylactic reactions. 1 3 Orchard et al reviewed 422 injections, and showed a systemic allergy rate of 2.6% upon re-exposure.…”

Section: Discussionsupporting

confidence: 64%

Aprotinin in the management of Achilles tendinopathy: a randomised controlled trial

Brown

Orchard²,

Kinchington³

et al. 2006

Br J Sports Med

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Background:Achilles tendinopathy is a common condition, which can become chronic and interfere with athletic performance. The proteinase inhibitor aprotinin (as injection) has been found to improve recovery in patellar tendinopathy1 (evidence level 1b2) and Achilles tendinopathy.3 Internationally this therapy is being used based on this limited knowledge base.Aim:To evaluate whether aprotinin injections decrease time to recovery in Achilles tendinopathy.Method:A prospective, randomised, double blind, placebo controlled trial was performed comparing saline (0.9%) plus local anaesthetic injections and eccentric exercises with aprotinin (30 000 kIU) plus local anaesthetic injection and eccentric exercise. Three injections were given, each a week apart. In total, 26 patients, with 33 affected tendons, were enrolled for this study.Results:At no follow up point (2, 4, 12, or 52 weeks) was there any statistically significant difference between the treatment group and placebo. This included VISA-A scores4 and secondary outcome measures. However, a trend for improvement over placebo was noted.Conclusion:In this study on Achilles tendinopathy, aprotinin was not shown to offer any statistically significant benefit over placebo. Larger multicentre trials are needed to evaluate the efficacy of aprotinin in Achilles tendinopathy.

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Section: Discussionsupporting

confidence: 64%

Aprotinin in the management of Achilles tendinopathy: a randomised controlled trial

Brown

Orchard²,

Kinchington³

et al. 2006

Br J Sports Med

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“…It may block matrix metalloproteinases (MMPs), including MMP-1, MMP-8 and MMP-13 (collagenases) and MMP-2 and MMP-9 (gelatinases), either directly or via inhibition of plasminogen and plasmin 83,84. The major side effect is anaphylaxis, which is particularly seen after repeated use of the drug 85,86. The rate of allergic reaction when using repeat injections of aprotinin (bovine-derived) is higher than for most medications and this represents a major factor to consider when choosing this drug 81,86…”

Section: Injectionsmentioning

confidence: 99%

New options in the management of tendinopathy

Maffulli

Longo²,

Loppini³

et al. 2010

OAJSM

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Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an “acute tendinopathy” is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic lesion, but act only to denervate them. They include endoscopy, electrocoagulation, and minimally invasive stripping. Further randomized controlled trials are necessary to clarify better the best therapeutic options for the management of tendinopathy.

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“…In patients with previous exposure, absence of IgG in serum [83] or negative skin test has a high negative predictive value for hypersensitivity reaction [85], but positive correlation with either IgG or IgE levels is poor with only very high levels of IgG correlating with reaction [86]. In contrast, Jaquiss and colleagues reported equal occurrence of hypersensitivity reactions to aprotinin in spite of previous and number of times of exposure, 1% to 2.9% in pediatric cardiac patients.…”

Section: Antifibrinolytic Agentsmentioning

confidence: 99%