Effects of Aprotinin Dosage on Renal Function

Dietrich, Wulf; Busley, Raimund; Boulesteix, Anne‐Laure

doi:10.1097/01.anes.0000299428.55062.67

Cited by 28 publications

(2 citation statements)

References 47 publications

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“…Dietrich, in a study of 8,548 cardiac surgical patients treated with different doses of aprotinin, showed no association of aprotinin dosage and postoperative hemodialysis or renal dysfunction. 5 The null hypothesis for this study is there is no difference in the incidence of renal failure and mortality between the use of different antifibrinolytic agents and the control group (off-pump) in coronary artery bypass patients. The primary outcomes of renal failure and mortality were compared to the results published in the larger observational study by Mangano.…”

Section: Introductionmentioning

confidence: 93%

Renal dysfunction in cardiac surgery: identifying potential risk factors

Barnum

Sistino

2009

Perfusion

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Aprotinin has been associated with increased renal failure and mortality when used in cardiac surgery. The purpose of this retrospective study was to compare the incidence of renal failure and mortality in our patient population to the published rates, accounting for risk factors associated with renal failure. After IRB approval; using the STS Database and cardiopulmonary bypass pump records, a total of 2292 cardiac patients were identified from January 2004 through June 2008. Forty-nine patients were excluded because they were on renal dialysis preoperatively. There were 1226 coronary artery bypass patients. Patients were separated into groups, according to which antifibrinolytic agent was used. This study included a total of 716 patients, divided into three groups; aprotinin (n = 436), tranexamic acid (n = 61), and off-pump coronary artery bypass (OPCAB) (n = 219). Epsilon aminocaproic acid (AMICAR) was given by the anesthesiologist to the majority of the remaining 510 patients and was not recorded on the bypass record. Therefore, patients given AMICAR were not included in this study. Outcomes included renal dialysis after surgery and mortality. Risk factors were identified and compared to patients in a study published by Mangano in the New England Journal of Medicine (N Engl J Med 2006; 354: 353-365). Aprotinin vs. control group showed no significant difference in risk factors for diabetes mellitus, hypertension, creatinine level above 1.3 mg/dl, or low ejection fraction. The percentage of patients requiring renal dialysis and mortality was less in Medical University of South Carolina (MUSC) patients than the other published study. Overall, the patients in the MUSC study had greater risk factors for renal failure, with the exception of patients with preoperative serum creatinine of >1.3 mg/dl (8.3 vs. 15.1%). This study does not show the same risk for renal failure associated with aprotinin that has been published elsewhere.

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Section: Introductionmentioning

confidence: 93%

Renal dysfunction in cardiac surgery: identifying potential risk factors

Barnum

Sistino

2009

Perfusion

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“…An analysis of 8548 patients published in 2008 found a lack of a dose-response relationship between aprotinin and renal failure [19], which can be explained by varying levels of glyphosate contamination in the administered drug. In 2008, Fergusson et al [20] compared aprotinin with another antifibrinolytic agent, aminocaproic acid, and found a greater than 50% relative increase for death within the first month linked to aprotinin.…”

Section: Introductionmentioning

confidence: 99%

Death as a Drug Side Effect in FAERS: Is Glyphosate Contamination a Factor?

Seneff¹,

Swanson²,

Li³

et al. 2015

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An analysis of selected datasets from the FDA's drug Adverse Event Reporting System (FAERS) leads us to hypothesize that glyphosate contamination in both food and drugs is a major contributor to chronic and acute kidney failure respectively. In chronic kidney failure, glyphosate-induced pancreatitis results in the release of trypsin, causing a leaky vasculature. The albumin-bound glyphosate escapes into the tissues, protecting the circulatory system and kidneys but resulting in multiple symptoms related to skin, gut, brain, bones, lungs, etc. The rare and poorly understood acute kidney failure response reported for protamine sulfate and Trasylol ® is strikingly similar to that associated with glyphosate poisoning. Both drugs are derived from biological tissues that are plausibly contaminated with glyphosate. These drugs protect from haemorrhage, which leads to retention of glyphosate in the vasculature, are followed by circulatory collapse and a high likelihood of death as an outcome. We support our argument by comparing symptom profiles of selected subsets of FAERS with those related to glyphosate poisoning, anomalous reactions to protamine sulfate, and conditions showing strong statistical time-trend correlations with glyphosate.

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