Recombinant aprotinin in coronary artery bypass graft operations

Abstract

We conclude that, at the dosages given, recombinant bovine aprotinin decreases surgical blood loss and transfusion requirements in patients undergoing coronary artery bypass grafting, but its use requires appropriate monitoring of heparin use during bypass. Whether higher dosages of aprotinin increase the risk of graft thrombosis must be further assessed with a larger patient sample.

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

“…29,36 66,75,[86][87][88][89][90][91][92][93][94][95][96][97][98][99] In addition, 12 studies compared treatment with the conventional dose of aprotinin with lower doses of aprotinin. 30,38,40,41,44,46,48,50,56,59,69,70 Lastly, in eight trials, a direct comparison was made between treatment with aprotinin and lysine analogues. 31,58,[61][62][63]65,100,101 There was only one trial directly comparing desmopressin with aprotinin, 66 and one trial directly comparing desmopressin with lysine analogues.…”

Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

“…24 Recently low-dose aprotinin regimens (half of the high-dose administered in the same way or 2×10 6 KIU pump-prime only) were investigated. [5][6][7][8][9][10][11][12] Hemostatic efficacy appeared to be compatible with (or slightly less than) the high-dose, although the prevalence of side effects seemed unchanged with keeping understandable graft patency. [10][11][12] Several investigations demonstrated that the low-dose aprotinin did not completely inhibit hyperfibrinolysis (although it partly did in some investigations), suggesting that main cause of the blood loss reduction was due to maintainance of the platelet adhesive function.…”

“…[5][6][7][8][9][10][11][12] Hemostatic efficacy appeared to be compatible with (or slightly less than) the high-dose, although the prevalence of side effects seemed unchanged with keeping understandable graft patency. [10][11][12] Several investigations demonstrated that the low-dose aprotinin did not completely inhibit hyperfibrinolysis (although it partly did in some investigations), suggesting that main cause of the blood loss reduction was due to maintainance of the platelet adhesive function. [6][7][8][9] The use of high-dose aprotinin showed a further reduction of blood loss; however, the risk of thromboembolic complications due to the additional effect of complete inhibition of the fibrinolytic process has been indicated.…”

“…[6][7][8][9] The use of high-dose aprotinin showed a further reduction of blood loss; however, the risk of thromboembolic complications due to the additional effect of complete inhibition of the fibrinolytic process has been indicated. 9,10,18 The very low-dose aprotinin regimen in the present study comprised 10 6 KIU in the pump-prime preceding 10 6 KIU administration before the CPB. This dosage resulted in smaller effects than the low-dose regimen previously investigated, because there was no continuous administration after CPB.…”

“…9,10,18 The present study was performed under a well-controlled anticoagulation protocol of a heparin/protamine management system during CPB and strict oral anticoagulant therapy by acetylsalicylic acid (ASA) and coumadin with or without heparin after surgery. The aim was to determine whether the hemostatic effect produced by the combination of normothermic perfusion and aprotinin use was still effective with the minimally reduced dose, and whether it influenced graft patency.…”