Influence of aprotinin on early graft thrombosis in patients undergoing myocardial revascularization

Abstract

One hundred sixty-five patients undergoing primary myocardial revascularization were prospectively entered into a randomized, double-blind, placebo-controlled study, in a single institution, in order to determine the influence of high- and low-dose aprotinin application on early coronary artery bypass graft patency. All patients were operated on by the same team and the three treatment groups were comparable in all demographic data and surgical variables. Postoperative chest tube drainage and transfusion requirements were significantly reduced in patients receiving high or low doses of aprotinin. In all patients vein and internal mammary artery graft patency was assessed by control coronary angiograms 4 to 15 days (median 8.2 days) postoperatively. In the high-dose aprotinin group, 140 of 142 vein grafts and in the low-dose aprotinin group all of the 128 vein grafts were patent compared with 138 of 139 in the placebo group. The difference was not statistically significant (P > 0.05). All pedicled internal mammary artery grafts were patent in the three treatment groups. The prevalence of perioperative myocardial infarction was evaluated by serial creatine kinase-myocardial band (CK-MB) isoenzyme measurements and by electrocardiographic recordings. No additional changes that could be attributed to aprotinin were observed. In conclusion, these results suggest that perioperative myocardial infraction secondary to aprotinin-induced native coronary artery or conduit thrombosis is not increased by aprotinin in patients undergoing primary myocardial revascularization.

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

“…Most of these trials show no significant differences between patients assigned aprotinin and controls. 41,43,53,59,73,74 In only one study was a small increase in the proportion of patients with an occluded graft after aprotinin treatment observed. 54 Our meta-analysis of the occurrence of perioperative myocardial infarction did not show an increased frequency of this complication in the aprotinin-treated patients compared with placebo-treated patients.…”

“…29,36 66,75,[86][87][88][89][90][91][92][93][94][95][96][97][98][99] In addition, 12 studies compared treatment with the conventional dose of aprotinin with lower doses of aprotinin. 30,38,40,41,44,46,48,50,56,59,69,70 Lastly, in eight trials, a direct comparison was made between treatment with aprotinin and lysine analogues. 31,58,[61][62][63]65,100,101 There was only one trial directly comparing desmopressin with aprotinin, 66 and one trial directly comparing desmopressin with lysine analogues.…”

Applications of Aprotinin in Cardiac Surgery

“…6,12 The effects of aprotinin on graft patency have been described in 8 reports of randomized controlled trials. 7,[12][13][14][15][16][17][18] Only one showed a concerning trend to increased graft occlusion in the aprotinin group (8.0%) versus the placebo group (4.9%). Graft occlusion was not accompanied by an increase in the incidence of myocardial infarction in any study.…”

Aprotinin

“…The use of aprotinin was not associated with an increased rate of early occlusion of saphenous vein or internal mammary artery grafts in controlled studies with coronary angiography [14][15][16][17].…”