Effects of Aprotinin on Hemostatic Mechanisms during Cardiopulmonary Bypass

Oeveren, Willem van; Jansen, Nicolaas J. G.; Bidstrup, Benjamin P.; Royston, D.; Westaby, S; Neuhof, H.; Wildevuur, Charles

doi:10.1016/s0003-4975(10)62153-4

Cited by 323 publications

(87 citation statements)

References 21 publications

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“…Although its exact mechanism of action has not been completely understood, it modulates coagulation factors by inhibiting plasmin and kallikrein activity [11,15]. In addition, it has been shown to stabilize platelet membrane receptors, thus improving platelet adherence and function [13].…”

Section: Introductionmentioning

confidence: 99%

Aprotinin in pediatric neuromuscular scoliosis surgery

et al. 2008

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Reduction of blood transfusions in patients with neuromuscular scoliosis can decrease potential complications such as immune suppression, infection, hemolytic reaction and viral transmission. Aprotinin (Trasylol Ò , Bayer), an antifibrinolytic, has proven to be effective in reducing blood loss in cardiac and liver surgery, but little data exists in patients undergoing spinal fusion for neuromuscular scoliosis. The purpose of this study was to evaluate the safety and efficacy of aprotinin in pediatric neuromuscular scoliosis patients undergoing spinal fusion. The medical records of all patients undergoing initial spinal fusions for neuromuscular scoliosis between January 1999 and March 2003 were reviewed to determine demographic data, perioperative data, wound drainage and number of transfusion required. Cases were compared to a matched group of historical controls. We had 14 patients in the aprotinin group and 17 in the control group. Total blood loss in the aprotinin group was significantly lower compared to the control group (715 vs. 2,110 ml; P = 0.007). Significantly less blood loss occurred in the aprotinin group when blood loss per kilogram was evaluated as well (23 vs. 60 ml/kg, respectively; P = 0.002). Intra-operative packed red blood cell (PRBC) transfusions were also significantly lower in the aprotinin group (1.25 vs. 3.16 units; P = 0.001). No clinical evidence of anaphylaxis, deep vein thrombosis (DVT) or renal failure was observed in the aprotinin group. After considering the price of drug therapy, operating room time, and the cost of blood products, the use of aprotinin saved an average of $8,577 per patient. In our series, the use of aprotinin resulted in decreased blood loss and a decreased rate of transfusions in children with neuromuscular scoliosis undergoing extensive spinal fusion. At out institution, the use of aprotinin is safe and cost effective for patients with neuromuscular scoliosis.

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Section: Introductionmentioning

confidence: 99%

Aprotinin in pediatric neuromuscular scoliosis surgery

et al. 2008

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“…(23) Fibrin degradation increases during CPB, and fibrin degradation products have been implicated in impaired fibrin formation, platelet dysfunction, and endothelial disruption resulting in capillary injury. (24,25) Moreover, plasmin, a potent platelet inhibitor, reportedly degrades platelet adhesion receptors Gp Ib and Gp IIb in vitro, and by 50% in vivo during CPB, most notably at hypothermic temperatures (1) When added to washed platelets, plasmin reduces platelet membrane Gp Ib content by approximately 75%. (25) Taken together, these observations suggest that stimulation of the fibrinolytic system in CPB may result in decreased platelet function.…”

Section: Discussionmentioning

confidence: 99%

A prospective randomized controlled study to assess the efficacy of aprotinin in paediatric cardiac surgery

Dhanasekaran¹,

Kumar²

2014

IOSRJDMS

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“…Future efforts will be exerted to assure more complete acceptance of our established guidelines and compliance with the principles of reducing usage of blood bank products. In addition, the use of other modalities which reduce postoperative bleeding in cardiac surgical patients, such as desmopressin and aprotinin, will be encouraged [27,28].…”

Section: Discussionmentioning

confidence: 99%

Limiting the Usage of Blood Products in Cardiovascular Surgery

1991

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We studied the effect of the initiation of a five part program of blood component conservation on blood product utilization in patients undergoing major cardiovascular surgery. We encouraged physicians and nurses to adhere to a set of guidelines that would limit the exposure of these patients to complications associated with blood product administration. Through this effort the amounts of packed red cells, fresh frozen plasma, platelets, and cryoprecipitate used were markedly reduced. After the start of the conservation program, overall blood product usage was reduced 29% despite a 46% increase in the surgical caseload, and there was a 53% decrease in the amount of donor exposure (units of individual blood products administered) per patient. Surgery. 1991; 11(2): 213-217 Modern transfusion practice in cardiac surgery is directed toward keeping the number of administered blood bank products to a minimum. In some hospitals, over 90% of patients undergoing coronary artery bypass grafting (CABG) do not receive any blood products as part of a comprehensive blood conservation program [1]. We recently reevaluated our use of blood products and embarked on a program to reduce the amount of patient exposure to infectious agents such as HIV-1 and hepatitis viruses. This effort was based on the following maneuvers whenever possible: removal of 450 to 900 ml of the patient's blood prior to cardiopulmonary bypass with reinfusion after reversal of heparinization; reinfusion of all possible blood from the oxygenator at the conclusion of bypass; withholding the prophylactic administration of fresh frozen plasma (FFP), platelets, and cryoprecipitate until laboratory tests indicated specific coagulation deficits; acceptance of postoperative normovolemic anemia (hematocrit, 25-30%); and reinfusion of postoperative mediastinal drainage. We report here the results of a concerted effort in the operating room and ICU to use less blood products in patients undergoing a variety of cardiac surgical operations. PE Horowitz, CM Lorenzen, RD Rhydderch, Limiting the Usage of Blood Products in Cardiovascular MethodsWe studied the blood product utilization of all patients at our hospital who were undergoing CABG, single valve replacement or repair, multiple valve operations, reoperations for valve repair or replacement, closure of atrial septal defect in patients above and below 16 years of age, and ventriculoseptal defect closure. All patients undergoing these operations from February 1 to August 31, 1988, were placed in the control group (Group I). A second group of patients operated on from May 1 to October 31, 1989 (Group II), was studied after the introduction of a new set of procedures and guidelines governing blood product administration. Limiting The Usage of Blood Products in Cardiovascular SurgeryAnnals of Saudi Medicine, Vol 11 No. 2; 1991 The following conservation techniques were utilized whenever possible for the patients in Group II: 1. Withdrawal of 450 to 900 ml of the patient's blood from the sideport of an 8.5 F percut...

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Effects of Aprotinin on Hemostatic Mechanisms during Cardiopulmonary Bypass

Cited by 323 publications

References 21 publications

Aprotinin in pediatric neuromuscular scoliosis surgery

Aprotinin in pediatric neuromuscular scoliosis surgery

A prospective randomized controlled study to assess the efficacy of aprotinin in paediatric cardiac surgery

Limiting the Usage of Blood Products in Cardiovascular Surgery

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