Effects of minimal-dose aprotinin on coronary artery bypass grafting

Hayashida, Nobuhiko; Isomura, Tadashi; Sato, Tohru; Maruyama, Hiroshi; Kosuga, K; Aoyagi, Shigeaki

doi:10.1016/s0022-5223(97)70154-5

Cited by 59 publications

(36 citation statements)

References 30 publications

(6 reference statements)

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“…Fractional sodium excretion (%NaExc) and fractional potassium excretion (%KExc) in percent were calculated as described previously. 12 The reference ranges of serum creatinine and creatinine clearance in our laboratory were 0.4-1.1 mg/dl and 80-120 ml·min -1 ·1.48 m -2 , respectively.…”

Section: Renal Functionmentioning

confidence: 73%

Does Off-Pump Coronary Artery Bypass Grafting Really Preserve Renal Function?

Hayashida

Teshima

Chihara

et al. 2002

Circ J

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Section: Renal Functionmentioning

confidence: 73%

Does Off-Pump Coronary Artery Bypass Grafting Really Preserve Renal Function?

Hayashida

Teshima

Chihara

et al. 2002

Circ J

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“…However, it significantly increased the levels of 2-plasmin inhibitor and plasminogen activator inhibitor, which suggested the existence of a weak inhibitory effect of fibrinolysis. 25 They also demonstrated prevention of coagulation and no important complications. Thus10 6 KIU aprotinin may be achieving desirable effect (hemostasis) and preventing undesirable side effect (thrombosis).…”

Section: Discussionmentioning

confidence: 94%

Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

Hara¹,

Onoguchi²,

Sasaki³

et al. 1999

Jpn Circ J

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“…1,[3][4][5] There was no significant difference in transfusion requirements of PRBCs between the two patient groups, which does not support findings from previous studies suggesting that aprotinin reduces transfusion requirements in patients undergoing cardiac surgery. [7][8][9][10][11] However, patients in the aprotinin group appeared to receive FFP more frequently than patients in the aminocaproic acid group. However, several patients in the aprotinin group were still taking clopidogrel prior to surgery and were therefore prophylactically given FFP at the end of the operation likely causing this variance.…”

Section: Discussionmentioning

confidence: 96%

“…6 Several studies demonstrate reduced transfusion requirements in patients receiving aprotinin either compared with placebo or with other antifibrinolytic agents. [7][8][9][10][11] Since a preponderance of evidence points towards aprotinin being a more powerful antifibrinolytic drug, one might expect an increase in postoperative bleeding and postoperative blood product transfusions in patients undergoing cardiac surgery after aprotinin was taken off the market. Therefore, we wanted to compare postoperative hemorrhage and transfusion rates, as well as morbidity and mortality rates in patients undergoing on-pump cardiac operations receiving either aprotinin or aminocaproic acid.…”

mentioning

confidence: 99%

The Effect of Antifibrinolytic Prophylaxis on Postoperative Outcomes in Patients Undergoing Cardiac Operations

Koul

Ferraris

Davenport

et al. 2012

International Surgery

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Antifibrinolytic agents such as aprotinin and epsilon aminocaproic acid limit postoperative bleeding and blood transfusion in patients undergoing cardiac operations using cardiopulmonary bypass (CPB). Recent evidence suggests that these agents have adverse side effects that influence operative mortality and morbidity. We studied postoperative bleeding, transfusion rates, and operative outcomes in our patients in order to assess the efficacy of these agents during cardiac operations requiring CPB. We reviewed records of 520 patients undergoing a variety of cardiac operations between January 2005 and May 2009. We measured multiple variables including pre-operative risk factors, antifibrinolytic agent used, and outcomes of operation, such as measures of bleeding and blood transfusion, as well as serious operative morbidity and mortality. Postoperative bleeding rates varied significantly between patients receiving aprotinin and those receiving aminocaproic acid (P , 0.05). There was an associated 12% decrease in operative site bleeding in aprotinin-treated patients compared with aminocaproic acid. There was no significant difference in the transfusion rates of packed red blood cells between patients receiving aminocaproic acid or aprotinin (P . 0.05), though individuals in the aprotinin group did receive FFP more frequently than patients in the aminocaproic acid group (P , 0.05). There was no significant difference in morbidity and mortality rates between patients in either drug group (P . 0.05). Our study shows that aprotinin is more effective at controlling operative site bleeding than aminocaproic acid. Reduced operative site bleeding did not portend better outcome or differences in transfusion requirements. Aminocaproic acid remains a safe and cost-effective option for antifibrinolytic prophylaxis because of unavailability of aprotinin.Key words: Aprotinin -Aminocaproic acid -Cardiac surgery -Postoperative bleedingChest tube output -Transfusion -Morbidity -Mortality P ostoperative hemorrhage is a common complication of cardiac operations, with over 50% of patients receiving blood product transfusions.1 For several years aprotinin was an antifibrinolytic drug used to decrease postoperative bleeding in patients undergoing cardiac surgery. This drug was removed from the United States market in November 2007 as studies suggested that its use is associated with increased end-organ damage and increased operative mortality rates. 2,3 Since that time, aminocaproic acid has been the most commonly used prophylactic agent for control of postoperative hemorrhage during cardiac operations.Several previous studies have suggested that aprotinin controls bleeding more effectively than other antifibrinolytic agents such as aminocaproic acid, 1,3-5 while others have suggested an equivalent hemostatic effectiveness among these agents.6 Several studies demonstrate reduced transfusion requirements in patients receiving aprotinin either compared with placebo or with other antifibrinolytic agents. 7-11Since a preponderance of evidence...

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Effects of minimal-dose aprotinin on coronary artery bypass grafting

Cited by 59 publications

References 30 publications

Does Off-Pump Coronary Artery Bypass Grafting Really Preserve Renal Function?

Does Off-Pump Coronary Artery Bypass Grafting Really Preserve Renal Function?

Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

The Effect of Antifibrinolytic Prophylaxis on Postoperative Outcomes in Patients Undergoing Cardiac Operations

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