Aprotinin and renal function in patients undergoing cardiac surgery

Hörl, W H

doi:10.1093/oxfordjournals.bja.a013377

Cited by 14 publications

(8 citation statements)

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“…24 Although several previous studies have also found an association between aprotinin use and renal dysfunction, others have not. 24 These studies, however, may have been underpowered for detecting a difference in renal function owing to their sample sizes and inclusion of low-risk patients. In addition, since volume of blood loss is an important risk factor for renal dysfunction, 25 the use of placebo controls may have biased the results in favor of aprotinin.…”

Section: Discussionmentioning

confidence: 98%

“…Excluding patients who received rFVIIa did not significantly alter the association between aprotinin and renal dysfunction (Table 5). It has been postulated that aprotinin may cause renal dysfunction by inhibiting renal afferent arteriole vasodilators kallikrein and prostaglandins, which has been shown to reduce renal blood flow and glomerular filtration rate 24 . Although several previous studies have also found an association between aprotinin use and renal dysfunction, others have not 24 .…”

Section: Discussionmentioning

confidence: 99%

“…It has been postulated that aprotinin may cause renal dysfunction by inhibiting renal afferent arteriole vasodilators kallikrein and prostaglandins, which has been shown to reduce renal blood flow and glomerular filtration rate 24 . Although several previous studies have also found an association between aprotinin use and renal dysfunction, others have not 24 . These studies, however, may have been underpowered for detecting a difference in renal function owing to their sample sizes and inclusion of low‐risk patients.…”

Section: Discussionmentioning

confidence: 99%

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A propensity score case‐control comparison of aprotinin and tranexamic acid in high‐transfusion‐risk cardiac surgery

et al. 2006

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A propensity score case‐control comparison of aprotinin and tranexamic acid in high‐transfusion‐risk cardiac surgery

et al. 2006

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“…Nevertheless, some possible effects of aprotinin on renal function have been both experimentally and clinically described, e.g. decreased kinin synthesis, diminished renal blood flow and glomerular filtration rate, and reversible tubular overload [16,17].…”

Section: Discussionmentioning

confidence: 99%

The blood sparing effect and the safety of aprotinin compared to tranexamic acid in paediatric cardiac surgery☆

Breuer

Martin

Wilhelm

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…Thus, the combination of aprotinin with ACE inhibitors or angiotensin II receptor blockers likely results in reduced renal blood flow and glomerular filtration rate. 60 The clinical evidence demonstrating renal injury associated with aprotinin is conflicting and inconclusive. Several randomized, placebocontrolled studies involving a combined total of more than 3000 patients have not demonstrated significant renal injury associated with aprotinin.…”

Section: Graft Patency and Myocardial Infarctionmentioning

confidence: 99%

Benefits and Risks of Aprotinin Use During Cardiac Surgery

Kristeller¹,

Roslund²,

Stahl³

2008

Pharmacotherapy

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Aprotinin is a serine protease inhibitor with antithrombotic, antifibrinolytic, and antiinflammatory effects. It is effective in reducing bleeding and the need for blood transfusions after cardiac surgery with cardiopulmonary bypass. Additional benefits, such as cerebral protection, are hypothesized but not yet thoroughly substantiated. The safety of aprotinin has been questioned based on a phase IV analysis of large data sets, including patients undergoing cardiac surgery. Potential risks including increased occurrences of stroke, myocardial infarction, renal failure, and death are implied by these analyses; however, adequate study group matching is lacking from these nonrandomized, retrospective studies. In October 2007, a large randomized controlled trial comparing antifibrinolytics in patients undergoing cardiac surgery was stopped after a preliminary analysis suggested a trend toward an increase in all-cause 30-day mortality associated with aprotinin. Subsequently, the manufacturer of aprotinin temporarily suspended marketing and halted all shipment of aprotinin on a worldwide basis. Pending a complete analysis of this study, the use of aprotinin could be considered as one component of a blood conservation strategy. After contemplating the benefits and risks of this controversial drug, clinicians should reserve its use for patients at high risk for postoperative blood loss.

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Aprotinin and renal function in patients undergoing cardiac surgery

Cited by 14 publications

References 0 publications

A propensity score case‐control comparison of aprotinin and tranexamic acid in high‐transfusion‐risk cardiac surgery

A propensity score case‐control comparison of aprotinin and tranexamic acid in high‐transfusion‐risk cardiac surgery

The blood sparing effect and the safety of aprotinin compared to tranexamic acid in paediatric cardiac surgery☆

Benefits and Risks of Aprotinin Use During Cardiac Surgery

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