Aprotinin for Primary Coronary Artery Bypass Grafting: A Multicenter Trial of Three Dose Regimens

Lemmer, J; Dilling, Emery W.; Morton, Jeremy R.; Rich, Jeffrey B.; Robicsek, Francis; Bricker, Donald L.; Hantler, Charles B.; Copeland, Jack G.; Ochsner, John L.; Daily, Pat O.; Whitten, Charles W.; Noon, George P.; Maddi, Rosemarie

doi:10.1016/s0003-4975(96)00451-1

Cited by 149 publications

(82 citation statements)

References 23 publications

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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%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Discussionmentioning

confidence: 99%

“…The administration of aprotinin in the pump-prime-only (2×10 6 KIU) was investigated in a multicenter trial. 12 Although the pump-primeonly dose was effective for hemostasis, there was concern about an association with a small increase in myocardial infarction. For this reason, although there was no appropriate explanation in the report, they did not recommend this regimen.…”

Section: Discussionmentioning

confidence: 99%

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Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

Hara¹,

Onoguchi²,

Sasaki³

et al. 1999

Jpn Circ J

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

Hara¹,

Onoguchi²,

Sasaki³

et al. 1999

Jpn Circ J

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“…[16][17][18] Aprotinin, a bovine serine protease inhibitor, directly inhibits plasmin, and at high doses, also inhibits kallikrein. Both EACA and tranexamic acid are lysine analogues that function in suppressing fibrinolysis.…”

Section: Use Of Antifibrinolytic Agents In Cpbmentioning

confidence: 99%

Perioperative Evaluation of Bleeding Diathesis

Leung¹

2006

Hematology

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The differential diagnosis of a long APTT with a normal prothrombin time can be due to either a clotting factor deficiency or the presence of an inhibitor, which can be distinguished by using a plasma-mixing study. The various clotting factor deficiency states are reviewed. Clinical bleeding following cardiac bypass surgery due to acquired factor V and thrombin antibodies is also reviewed.In this brief review, a few selected topics on evaluation of bleeding diathesis in either a preoperative or postoperative setting will be discussed. Evaluation of a Prolonged APTT before SurgeryIt is fairly common that a hematologist is asked to see a patient, sometimes urgently, for evaluation of a long APTT discovered in a pre-operative setting. The anticipated surgery may vary from a relatively minor procedure to a major operation such as open-heart surgery or CNS surgery.The differential diagnosis of a long APTT with a normal prothrombin time is quite extensive, but can be divided into two groups, due to either a clotting factor deficiency or the presence of an inhibitor. The patient's history and physical examination are obviously important in considering the various possibilities. In eliciting a bleeding history, one should recognize its limitations. Mild bleeding symptoms are astonishingly common in the general population-epistaxis, easy bruising, and gum bleeding are reported in up to 25-45% of apparently healthy people, many of whom do not have any identifiable bleeding disorders.

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Reduction in Costs, Blood Products, and Operating Time in Patients Undergoing Open Heart Surgery

Lazzara

Kidwell²,

Kraemer³

et al. 1997

Arch Surg

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Aprotinin for Primary Coronary Artery Bypass Grafting: A Multicenter Trial of Three Dose Regimens

Cited by 149 publications

References 23 publications

Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

Perioperative Evaluation of Bleeding Diathesis

Reduction in Costs, Blood Products, and Operating Time in Patients Undergoing Open Heart Surgery

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