Effects of aprotinin on blood loss, platelet function, fibrinolysis, complement, and renal function after cardiopulmonary bypass

Blauhut, B.; Necek, S; Grod, Ch.; Brücke, P; Je, Doran; Späth, P.; Lundsgaard-Hansen, P; Roscic, D.

doi:10.1016/0888-6296(90)90104-n

Cited by 27 publications

(39 citation statements)

References 4 publications

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“…Blauhat et al reported an increase of fractional sodium excretion during the late intraoperative and early postoperative stages, 18 which might reflect incipient renal tubular failure, but they also demonstrated that tubular dysfunction was unremarkable 24 h after the operation. In agreement with their results, we also found that the fractional sodium excretion increased similarly in both groups during the first postoperative day and returned to the preoperative value by 2 days after operation.…”

Section: Discussionmentioning

confidence: 99%

Does Off-Pump Coronary Artery Bypass Grafting Really Preserve Renal Function?

Hayashida

Teshima

Chihara

et al. 2002

Circ J

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Section: Discussionmentioning

confidence: 99%

Does Off-Pump Coronary Artery Bypass Grafting Really Preserve Renal Function?

Hayashida

Teshima

Chihara

et al. 2002

Circ J

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“…4346 The only evaluation of renal function in patients receiving high-dose aprotinin also reported no untoward effect on serum electrolytes, osmolarity and creatinine, and creatinine clearance. 47 The only major side effect caused by aprotinin is a hypersensitivity reaction, which is more likely to occur after previous exposure to the drug, and has an overall incidence of approximately 0.1%.13'42 Previous exposure to aprotinin was the only exclusion criterion in a study by Bidstrup et al, presumably on this basis. 46 However, repeated use of aprotinin in a small series of 15 patients by Freeman was not associated with allergic phenomena.…”

Section: Pharmacokinetic Behaviour and Side Effectsmentioning

confidence: 99%

Natural and synthetic antifibrinolytics in cardiac surgery

1992

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In an effort to reduce morbidity associated with transfusion of blood products, the use of antifibrinolytics to decrease bleeding and transfusions after cardiopulmonary bypass ( CPB) is receiving widespread attention. The predominant haemostatic defect induced by CPB and, therefore Afin de rdduire morbiditd associde aux transfusion sanguines, les anesthdsistes et les chirurgiens cardiaques utilisent de plus en plus les antifibrinolytiques darts le but de diminuer le saignement et les besoins transfusionnels secondaires it la circulation extracorporelle ( CEC). Les modifications de l 'hdmostase induites

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“…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. Esse regime mostrou, em vários estudos, reduzir a perda de sangue em até 50% e diminuir a necessidade de transfusão de 40% a 80% em intervenção cirúrgica cardíaca com CEC [39][40][41][42] . Além desse, que é o mais adota e estudado, têm sido empregados regimes com doses mais baixas.…”

Section: Aprotininaunclassified

“…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. Several studies demonstrated that this regimen reduces blood loss by up to 50% and the need of transfusion in 40% to 80% of the cases of cardiac surgery with CPB [39][40][41][42] . Besides this regimen, the one used more often and that has been studied the most, regimens with lower doses have been used.…”

Section: Aprotininmentioning

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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Effects of aprotinin on blood loss, platelet function, fibrinolysis, complement, and renal function after cardiopulmonary bypass

Cited by 27 publications

References 4 publications

Does Off-Pump Coronary Artery Bypass Grafting Really Preserve Renal Function?

Does Off-Pump Coronary Artery Bypass Grafting Really Preserve Renal Function?

Natural and synthetic antifibrinolytics in cardiac surgery

Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

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