Effects of high-dose aprotinin on renal function in aortocoronary bypass grafting

Feindt, P.; Walcher, Sandra; Volkmer, I; Keller, H. E.; Straub, U; Huwer, Hanno; Seyfert, U. T.; Petzold, Thomas; Gams, E.

doi:10.1016/0003-4975(95)00525-p

Cited by 55 publications

(19 citation statements)

References 13 publications

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“…For many years there have been intermittent reports of possible adverse effects of aprotinin such as myocardial infarction or renal dysfunction [5 Cosgrove, 6 Sundt, 7 Feindt]. In 2006 Mangano, et al reported in an influential article in the New England Journal of Medicine that aprotinin increased the risk of renal failure requiring dialysis, myocardial infarction and stroke [8 Mangano].…”

Section: Introductionmentioning

confidence: 99%

Optimal dose of aprotinin for neuroprotection and renal function in a piglet survival model

Iwata

Okamura

Ishibashi

et al. 2009

The Journal of Thoracic and Cardiovascular Surgery

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Objective The efficacy of aprotinin in reducing blood loss after CPB is well established although its neuroprotective potential is less well known. Furthermore, there is controversy regarding optimal dosing and possible renal complications. Methods 54 piglets were randomized to one of three CPB groups designed to carry risk of post-op cerebral and renal dysfunction: circulatory arrest at 25°C, ultra-low flow (10 ml/kg/min) at either 25°C or 34°C. Animals were randomized to: control (no aprotinin), low dose (30,000 KIU/kg into prime only), standard full dose (30,000 KIU/kg bolus IV into prime plus 10,000 KIU/kg infusion), and double full dose. Tissue oxygenation index (TOI) was monitored by near-infrared spectroscopy (NIRS). Neurologic functional and histological scores, creatinine and blood urea nitrogen (BUN) were outcomes of interest. Results Aprotinin significantly improved neurological scores on postoperative day 1 after ultra-low flow bypass at 25°C or 34°C (P<.01), but not after HCA (P=.57). Linear regression indicated a strong dose-response relationship with higher aprotinin doses having the best neurological scores. During LF, a higher TOI was correlated with a higher aprotinin dose (P<.05). Aprotinin dose had no significant effect on creatinine or BUN on day 1. Low body weight was the only predictor of high BUN (r = −0.39, P<.01). Conclusion Aprotinin significantly improves neurologic recovery without compromising renal function in the young piglet.

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Section: Introductionmentioning

confidence: 99%

Optimal dose of aprotinin for neuroprotection and renal function in a piglet survival model

Iwata

Okamura

Ishibashi

et al. 2009

The Journal of Thoracic and Cardiovascular Surgery

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“…Negative side effects could be found also for the kidney [10][11][12], especially at low body temperatures [13]. Moreover, an aprotinin-induced increase in the risk of graft thrombosis was found after myocardial revascularizations [14].…”

Section: Introductionmentioning

confidence: 99%

Effects of aprotinin on endothelium-dependent relaxation of large coronary arteries☆

Fischer

Steinhoff

2005

European Journal of Cardio-Thoracic Surgery

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For clinically relevant concentrations of aprotinin up to 500 KIU/ml, no significant reduction of the EDR can be found in epicardial coronary arteries of the pig. For higher doses of 1000 KIU/ml, a reduction in NO production seems to be the cause of the small but significant reduction of the EDR by aprotinin. Therefore, danger for impairment of coronary EDR by aprotinin at clinical dosage levels, as suggested by studies on rat aortas, seems to be absent in coronary arteries of a large mammalian model.

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“…All patients had increased urinary levels of protein HC, which has also been found after coronary by-pass surgery (Feindt et al 1995). Stegmayr et al (1992) and Wahlstrom et al (1992a, b) also noted signs of tubular involvement after THR.…”

Section: Discussionmentioning

confidence: 55%

Renal impairment after hip or knee arthroplasty: Urinary excretion of protein markers studied in 59 patients

Nergelius

Vinge

Grubb

et al. 1997

Acta Orthopaedica Scandinavica

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Effects of high-dose aprotinin on renal function in aortocoronary bypass grafting

Cited by 55 publications

References 13 publications

Optimal dose of aprotinin for neuroprotection and renal function in a piglet survival model

Optimal dose of aprotinin for neuroprotection and renal function in a piglet survival model

Effects of aprotinin on endothelium-dependent relaxation of large coronary arteries☆

Renal impairment after hip or knee arthroplasty: Urinary excretion of protein markers studied in 59 patients

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