Evaluating the safety implications of aprotinin use: The Retrospective Evaluation of Aprotinin in Cardio Thoracic Surgery (REACTS)

Coleman, Craig I.; Rigali, Vera T.; Hammond, Jonathan; Kluger, Jeffrey; Jeleniowski, Kenneth W.; White, C Michael

doi:10.1016/j.jtcvs.2007.01.069

Cited by 23 publications

(10 citation statements)

References 16 publications

(35 reference statements)

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“…The literature reveals signifi cant support for the effi cacy of all three drugs for decreasing bleeding, with current data suggesting no significant difference in effi cacy among these drugs [ 232 ]. Aprotinin was withdrawn from the market in 2008 due to the risk of renal dysfunction and death in adult cardiac surgery [ 233 ]. These detrimental effects have not been reproduced in children.…”

Section: Effects On Bleeding and Coagulationmentioning

confidence: 99%

Anesthesia for Cardiac Surgery in Neonates

Miller‐Hance

Gottlieb

Motta

2014

Neonatal Anesthesia

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Section: Effects On Bleeding and Coagulationmentioning

confidence: 99%

Anesthesia for Cardiac Surgery in Neonates

Miller‐Hance

Gottlieb

Motta

2014

Neonatal Anesthesia

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“…Aprotinin has been used to prevent blood loss during major surgery, which is its major indication 80–82. Aprotinin is an 85 amino-acid, 65 kD basic polypeptide extracted from bovine lungs.…”

Section: Injectionsmentioning

confidence: 99%

New options in the management of tendinopathy

Maffulli

Longo²,

Loppini³

et al. 2010

OAJSM

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Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an “acute tendinopathy” is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic lesion, but act only to denervate them. They include endoscopy, electrocoagulation, and minimally invasive stripping. Further randomized controlled trials are necessary to clarify better the best therapeutic options for the management of tendinopathy.

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“…9,10 Reported safety concerns with aprotinin primarily include mortality, 5,8,9,11,12 renal failure, 6,12-14 renal dysfunction, 3,15,16 and stroke, 13,15,17 and, to a lesser extent, myocardial infarction. 13 In May 2008, the results of a randomized control trial, Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART), provided the most convincing evidence for the adverse outcomes associated with the use of aprotinin.…”

Section: Introductionmentioning

confidence: 99%