Effect of Aprotinin on Need for Blood Transfusion After Repeat Open-Heart Surgery

Royston, David; Taylor, Kenneth M.; Bidstrup, Benjamin P.; Sapsford, Ralph N.

doi:10.1016/s0140-6736(87)91190-1

Cited by 644 publications

(230 citation statements)

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“…A aprotinina teve o seu emprego comprovado como fármaco poupador de sangue em vários ensaios clínicos com distribuição aleatória de pacientes e três metanálises [33][34][35] . Inclusive em pacientes com alto risco para sangramento, a aprotinina demonstrou ser efetiva para reduzir sangramento e transfusões em cirurgia cardíaca com CEC [36][37][38] . Na maioria das vezes, a aprotinina é utilizada em altas doses que foram estabelecidas por Roystron e col. 36 , no Hospital Hammersmith.…”

Section: Aprotininaunclassified

“…Inclusive em pacientes com alto risco para sangramento, a aprotinina demonstrou ser efetiva para reduzir sangramento e transfusões em cirurgia cardíaca com CEC [36][37][38] . Na maioria das vezes, a aprotinina é utilizada em altas doses que foram estabelecidas por Roystron e col. 36 , no Hospital Hammersmith. Devido ao fato de a meia-vida de eliminação situar-se entre uma e sete horas, o regime recomendado consta de uma dose inicial é de 2 × 10 6 UIK (2.000.000 UIK), outra dose igual na CEC e infusão contínua de 5 × 10 5 UIK.h -1 durante todo o procedimento cirúrgico.…”

Section: Aprotininaunclassified

“…The use of aprotinin as a blood-sparing drug has been demonstrated in several clinical studies, with random distribution of patients, and 3 meta-analyses [33][34][35] . It has been demonstrated that aprotinin is effective in reducing bleeding and blood transfusions in cardiac surgeries with CPB, even in patients with increased risk of bleeding [36][37][38] . Aprotinin is used, mostly, in high doses, as established by Roystron et al 36 at the Hammersmith Hospital.…”

Section: Aprotininmentioning

confidence: 99%

“…It has been demonstrated that aprotinin is effective in reducing bleeding and blood transfusions in cardiac surgeries with CPB, even in patients with increased risk of bleeding [36][37][38] . Aprotinin is used, mostly, in high doses, as established by Roystron et al 36 at the Hammersmith Hospital. Since its elimination half-life is between 1 and 7 hours, the recommended regimen consists of an initial dose of 2 x 10 6 KIU (2,000,000 KIU), followed by the same dose in the CPB, and continuous infusion of 5 x 10 5 KIU.h -1 during surgery.…”

Section: Aprotininmentioning

confidence: 99%

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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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Section: Aprotininaunclassified

Section: Aprotininmentioning

confidence: 99%

Section: Aprotininmentioning

confidence: 99%

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Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

Santos¹,

Splettstosser²,

Warpechowski³

et al. 2007

Rev. Bras. Anestesiol.

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“…Aprotinin has been the most widely studied antifibrinolytic that has been shown to reduce blood loss and the need for transfusion of blood products in patients having reoperation involving cardiopulmonary bypass. [2][3][4][5][6] Reoperative cardiac surgery has a greater risk for bleeding and the need for transfusion due to tedious dissection of scarred and obscured landmarks.…”

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confidence: 99%

Tranexamic acid reduces blood loss and transfusion in reoperative cardiac surgery

et al. 1997

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Purpose: The objective of this study was to assess the effect of tranexamic acid 0"A), a synthetic antifibrinolytic, on blood loss and the need for transfusion of blood products following repeat cardiac valve surgery. Methods: After ethics committee approval, 41 patients scheduled for reoperative valve replacement were enrolled in this randomized, double blind, placebo controlled study. Patients were randomized to receive TA (I 0 g in 500 ml NSaline) or placebo (NSaline) as an/v bolus over 30 rain, after anaesthesia induction and prior to skin incision. Intraoperative blood loss was assessed by estimating blood volume on drapes, weighing surgical sponges, and measuring suction bottle returns. Postoperative blood loss was measured from mediastinal chest tube drainage following surgery. Blood products were transfused according to a standardized protocol, Results: Patient demographics were similar for age, sex, cardiopulmonary bypass pump time, cross damp time, surgical time, preoperative haemoglobin, coagulation profile, and the number of valves replaced during surgery. Tranexamic acid administration reduced intraoperative blood loss [median (range)] from 1656 (575-6270) to 720 ml (355-5616) (P < 0.01) and postoperative blood loss from 1170 (180-4025) to 538 ml (135-1465) (Intent to Treat n =4 I, P < 0.01 ). The total red blood cells transfused (median, range) was reduced from 1500 (0-9300) ml to 480 (0-2850) ml (P < 0.01) in the TA group. In hospital complications and mortality rates were not reduced in the TA group. Conclusion:Tranexamic acid reduced blood loss and the need for blood product transfusion and appears to be an effective treatment for patients undergoing reoperative cardiac valvular surgery.Objectif : l~valuer l'influence de l'acide trar~xamique (AT), un antifibrinolytique synth&ique, sur les pertes sanguines et le besoin de transfuser des produits sanguins aprEs une r~ol~ration cardiaque valvulaire. M&hodes : AprEs l'approbation du comit~ d'Ethique, 41 patients ont Et~ recrut& dans cette Etude alEatoire, en double aveugle et contr61Ee par placebo. Les patients ont EtE repartis alEatoirement pour recevoir de I'AT (I 0 g dans 500 ml de sol.phys.) ou un placebo (sol. phys,) en bolus iv en 30 rain aprEs l'induction de l'anesthEsie et avant l'incision de la peau. Les pertes sanguines peropEratoires ont EtE (~valuEes en estimant le volume sanguin perdu darts les champs Ol~ratoires, en pesant les compresses, et en mesurant le volume sanguin recueilli par aspiration,/~, la p&iode postopEratoire, le sang recueilli par les drains mEdiastinaux a Et~ mesurE. Les produits du sang ont EtE administrEs selon un protocole standardis~. lld~tdtats : Les donn~3es d~mogr-aphiques ~aient identiques pour I'~ge, le sexe, la durC~ de circulation extracorporelle, du clampage et de la chirurgie, I'h~mogtobine pn~opEratoire, le bilan de la coagulation et le hombre de valves remplac~es. I'administration d'AT a r~duit les pertes sanguines peropEratoires [m~diane (&art)] de 1665 (572--6 270) ~ 720 ml (335--5 616) (P < 0,01) et l...

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Antifibrinolytic drugs and perioperative hemostasis

Slaughter

Greenberg

1997

Am. J. Hematol.

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Although excessive bleeding is widely recognized as a common complication of cardiac surgery, the recent success of antifibrinolytic drugs as prophylactic hemostatic agents has received little attention outside the surgical literature. The etiology of the coagulopathy following cardiac surgery is clearly multifactorial; however, the success of antifibrinolytic drugs as hemostatic agents suggests that fibrinolysis contributes to bleeding in this setting. Increasingly widespread administration of these drugs necessitates increased awareness of the risks and benefits posed by perioperative antifibrinolytic therapy. The objectives of this review are to understand the mechanisms of action of antifibrinolytic drugs in the context of the normal hemostatic response and to review evidence pertaining to the efficacy and safety of antifibrinolytic drugs as hemostatic agents during cardiac surgery. Am.

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Effect of Aprotinin on Need for Blood Transfusion After Repeat Open-Heart Surgery

Cited by 644 publications

References 10 publications

Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

Tranexamic acid reduces blood loss and transfusion in reoperative cardiac surgery

Antifibrinolytic drugs and perioperative hemostasis

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