High-dose Aprotinin in Cardiac Surgery—A Prospective, Randomized Study

Abstract

Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 unitslhr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95 % confidence interval (Cl) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.

Medical Haemostasis in Acute Hepatocyte Injury and Experimental Liver Trauma

“…The contact activation, which is the stimulator of intrinsic pathway of coagulation, is inhibited with aprotinin. In recent studies it has been shown that aprotinin prevents fibrinolysis by plasmin inhibition rather than kallikrein inhibition and prevents thrombocyte aggregation when applied in higher doses 8,9 , 19 . It also produces an antifibrinolytic effect by a decrease in the formation of fibrin degradation products, activation of α‐2‐antiplasmin, t‐PA inhibitors, and a decrease in release of t‐PA from endothelial cells 8,9 .…”

Tabula viva chirurgi: a living surgical document

“…A randomised, double-blind study from a single centre, on the effect of aprotonin on cardiac surgery (50 CABG cases and 50 valve cases), was conducted in the early 1990s at Groote Schuur Hospital 11. This study had exclusion criteria and was not representative of a cardiac surgical practice.…”