Aprotinin Reduces Cardiac Troponin I Release and Inhibits Apoptosis of Polymorphonuclear Cells During Off-Pump Coronary Artery Bypass Surgery

Abstract

Objectives: In addition to blood-sparing effects, aprotinin may have cardioprotective and anti-inflammatory effects during cardiopulmonary bypass-assisted cardiac surgery. In this study, the authors examined whether aprotinin had cardioprotective and/or anti-inflammatory effects in patients undergoing off-pump coronary artery bypass grafting.Design: A prospective randomized clinical trial. Setting: University hospital. Participants: Fifty patients were randomized to control (n ‫؍‬ 25) or aprotinin treatment (n ‫؍‬ 25) groups.Interventions: Aprotinin was given as a loading dose (2 ؋ 10 6 KIU) followed by a continuous infusion at 5 ؋ 10 5 KIU/h until skin closure.Measurements and Main Results: Blood samples for cardiac troponin I; interleukin-6, interleukin-8, and interleukin-10; tumor necrosis factor ␣; and elastase were taken after anesthesia induction, completion of revascularization, and 6 hours, 12 hours, and 24 hours after revascularization. Blood samples were taken to assess for apoptosis in polymorphonuclear cells. Baseline plasma levels for cardiac troponin I did not differ between groups but were significantly lower in aprotinin-treated patients at the time of revascularization (p ‫؍‬ 0.03) and 6 hours (p ‫؍‬ 0.004) and 24 hours (p ‫؍‬ 0.03) later. Aprotinin significantly reduced apoptosis in polymorphonuclear cells compared with control-treated patients (p ‫؍‬ 0.04). There were no differences in plasma cytokine or elastase levels between groups.Conclusions: The authors conclude that aprotinin reduces perioperative cardiac troponin I release and attenuates apoptosis in polymorphonuclear cells but has no significant effects on plasma cytokine levels in patients undergoing off-pump coronary artery bypass graft surgery.

Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

“…Normal saline placebo was given at the same time as aprotinin doses for the purpose of blinding.Aprotinin group received 200ml (2 million KIU=280mg) of aprotinin administered 20 minutes before sternotomy and 200mL (2 million KIU = 280mg) administered as a continuous infusion of 50ml/hr (500,000 KIU) until closure of the chest. Outcomes Outcomes reported: Number of patients exposed to allogeneic blood, allogeneic blood usage (units), fresh frozen plasma (units), platelets (units), blood loss, mortality, myocardial Infarctions, haematocrit levels, stroke, thrombotic complications, re-exploration for bleedingNotesQuality assessment score (Schulz criteria): 4/7Transfusion protocol used. All patients received ASA until the day of the operation (100mg/day).All patients received cell salvage (Imed 960) - 8 hours post-operatively Risk of bias Item Authors’ judgement Description Adequate sequence generation?YesRandom code used for randomisationAllocation concealment?UnclearAdequate - drug solutions were prepared by the hospital pharmacyBlinding?All outcomesYesDouble blind Bert 2008…”