Renal dysfunction and intravascular coagulation with aprotinin and hypothermic circulatory arrest

Sundt, Thoralf M.; Kouchoukos, Nicholas T.; Saffitz, Jeffrey E.; Murphy, Suzan F.; Wareing, Thomas H.; Stahl, David

doi:10.1016/0003-4975(93)91082-x

Cited by 181 publications

(60 citation statements)

References 22 publications

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“…4,5 Similarly, earlier studies reported an ineffective or putative impact of aprotinin on blood loss or transfusion requirements in patients with circulatory arrest. 4,5 In a study by Westaby and colleagues, 4 the mean blood loss in 27 patients not administered aprotinin was 837 mL over a period of 24 hours. In contrast, the 53 aprotinin-treated patients had an average 24-hour blood loss of 1929 mL.…”

Section: Mora Mangano Et Al Aprotinin Blood Loss Renal Dysfunction mentioning

confidence: 88%

“…4,5 Importantly, these investigations were conducted before the identification of appropriate heparin treatment strategies for patients receiving aprotinin, and patients in these studies probably received inadequate dosages of heparin. 4,5 Similarly, earlier studies reported an ineffective or putative impact of aprotinin on blood loss or transfusion requirements in patients with circulatory arrest. 4,5 In a study by Westaby and colleagues, 4 the mean blood loss in 27 patients not administered aprotinin was 837 mL over a period of 24 hours.…”

Section: Mora Mangano Et Al Aprotinin Blood Loss Renal Dysfunction mentioning

confidence: 99%

“…2,3 However, the publication of reports describing excessive thromboembolic events and end-organ damage in DHCA patients receiving aprotinin has prevented the routine adoption of this drug. 4,5 The affect of aprotinin on renal function is arguably one of the least well-defined or understood of the phenomena observed in patients undergoing DHCA. The majority of publications assessing the impact of aprotinin in hypothermic circulatory arrest include a retrospective study design; this lack of prospective trials has contributed to the confusion regarding the safety and efficacy of aprotinin in DHCA.…”

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confidence: 99%

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Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Mangano¹,

Neville²,

Hsu³

et al. 2001

Circulation

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Background-The technique of deep hypothermic circulatory arrest (DHCA) for cardiothoracic surgery is associated with increased risk for perioperative blood loss and renal dysfunction. Although aprotinin, a serine protease inhibitor, reduces blood loss in patients undergoing cardiopulmonary bypass, its use has been limited in the setting of DHCA because of concerns regarding aprotinin-induced renal dysfunction. Therefore, we assessed the affect of aprotinin on both blood transfusion requirements and renal function in patients undergoing cardiovascular surgery and DHCA. Methods and Results-We reviewed the records of 853 patients who underwent aortic or thoracoabdominal surgery at Stanford University Medical Center between January 1992 and March 2000. Two hundred three of these patients were treated with DHCA, and 90% (183) survived for more than 24 hours. Preoperative patient characteristics and intraoperative and postoperative clinical and surgical variables were recorded, and creatinine clearance (CRCl) was calculated for the preoperative and postoperative periods; renal dysfunction was prospectively defined as a 25% reduction in CRCl. The association between perioperative variables, including aprotinin use, and renal dysfunction was assessed by ANOVA techniques. Total urine output was 1294Ϯ1024 mL and 3492Ϯ1613 mL during and after surgery, respectively. CRCl decreased significantly after DHCA from 86Ϯ8 mL/min (before surgery) to 67Ϯ4 mL/min (in the intensive care unit) (PϽ0.01). Thirty-eight percent of patients (70 of 183) had postoperative renal dysfunction. Multivariate regression analyses identified 5 factors independently associated with a Ͼ25% reduction in CRCl: requirement for Ն5 U of packed red blood cells (Pϭ0.0002; ORϭ2.1), Յ800 mL of urine collected in the operating room (Pϭ0.0011; ORϭ1.9), nonuse of dopamine (Pϭ0.0430; ORϭ1.6), hematocrit Յ21 mg% (Pϭ0.0343; ORϭ1.5), and Յ2100 mL of urine during the first 24 hours in the intensive care unit (Pϭ0.0039; ORϭ2.0). Aprotinin did not increase the likelihood of postoperative renal dysfunction (Pϭ0.951), nor did it significantly reduce packed red blood cell transfusion requirements in either primary (nϭ107) (Pϭ0.456) or reoperative cardiovascular (nϭ76) (Pϭ0.176) procedures. During the operative period, the aprotinin group received a greater number of units of platelets (10.0 versus 6.6 U, PϽ0.012), fresh frozen plasma (4.8 versus 3.1 U, PϽ0.03), and cryoprecipitate (9.9 versus 5.4 U, PϽ0.002) than patients not prescribed aprotinin. Similarly, patients given aprotinin received more cryoprecipitate in the intensive care unit (

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Section: Mora Mangano Et Al Aprotinin Blood Loss Renal Dysfunction mentioning

confidence: 88%

Section: Mora Mangano Et Al Aprotinin Blood Loss Renal Dysfunction mentioning

confidence: 99%

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confidence: 99%

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Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Mangano¹,

Neville²,

Hsu³

et al. 2001

Circulation

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“…5,9,11,12 However, concerns about the side effects of a high dose, such as early vein graft occlusion and renal dysfunction, have been raised 18,[21][22][23] and it has been suggested that these side effects may be dose-dependent. 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.…”

Section: Discussionmentioning

confidence: 99%

Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

Hara¹,

Onoguchi²,

Sasaki³

et al. 1999

Jpn Circ J

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“…Blood transfusion was recorded until the patient was conveyed from the intensive care unit (ICU), and blood products required for bypass circuit were excluded from the transfusion requirements because the blood requirements for priming depended on the patient's hematological condition. The cumulative volume of postoperative mediastinal chest tube drainage was recorded hourly and was calculated at 4,8,12,16,20, and at 24 hours after the patient first reached the ICU.…”

Section: Methodsmentioning

confidence: 99%

Influence of heparin dosage on hemostasis under combined use of nafamostat mesilate during deep hypothemic circulatory arrest

Nakamura

Onitsuka

Yano

et al. 2003

Jpn J Thorac Caridovasc Surg

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Renal dysfunction and intravascular coagulation with aprotinin and hypothermic circulatory arrest

Cited by 181 publications

References 22 publications

Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

Influence of heparin dosage on hemostasis under combined use of nafamostat mesilate during deep hypothemic circulatory arrest

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