Putting the record straight on aprotinin as safe and effective: Results from a mixed treatment meta-analysis of trials of aprotinin

Howell, Neil; Senanayake, Eshan; Freemantle, Nick; Pagano, Domenico

doi:10.1016/j.jtcvs.2012.07.018

Cited by 57 publications

(39 citation statements)

References 16 publications

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“…However, the trial was stopped prematurely because of an increase in mortality in the aprotinin group. 35 Subsequent studies found it safe, 36 resulting in a reintroduction in some instances. Taking the elective and safe nature of OS into account and that alternative hemostatic adjuncts are available, these should be the first-choice drugs.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Bleeding in Orthognathic Surgery—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Olsen

Skov

Ingerslev

et al. 2016

Journal of Oral and Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Prevention of Bleeding in Orthognathic Surgery—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Olsen

Skov

Ingerslev

et al. 2016

Journal of Oral and Maxillofacial Surgery

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“…Aprotinin functions via the same mechanism as PAI-1, while lysine analogs, such as 6-aminocaproic acid and TXA, block the lysine-binding sites on plasminogen, thereby preventing the activation of plasmin and fibrin clot-degradation (19). The USA Food and Drug Administration has removed aprotinin, a bovine product, from the market due to statistical associations with renal failure, cerebrovascular events and mortality, without significantly stronger antifibrinolytic effects over other medications within the class (23)(24)(25). As a natural constituent of blood, VLHL PAI-1 may be free of side effects in addition to being an efficient antifibrinolytic agent.…”

Section: Discussionmentioning

confidence: 99%

Comparison between the clot-protecting activity of a mutant plasminogen activator inhibitor-1 with a very long half-life and 6-aminocaproic acid

Kindell

Keck

Jankun

2015

Experimental and Therapeutic Medicine

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“…En cirugía cardíaca, un metaanálisis publicado en 2009 mostraba que el uso de APT se asociaba con un incremento de la mortalidad con respecto al ATX 41 , pero 2 metaanálisis recientes han sembrado dudas sobre la supuesta mayor toxicidad de la APT en comparación con los análo-gos de la lisina 42,43 . Finalmente, un cuarto metaanálisis de estudios aleatorizados y observacionales encuentra que, en comparación con análogos de la lisina, la APT puede asociarse con un mayor riesgo de mortalidad en cirugía cardíaca de riesgo bajo e intermedio, pero parece no afectar la mortalidad en cirugía cardíaca de alto riesgo 44 .…”

Section: Seguridad De La Aprotininaunclassified

Foro de debate: seguridad de las alternativas a la transfusión alogénica en el paciente quirúrgico y/o crítico

Gómez

Vives

Basora³

et al. 2015

Medicina Intensiva

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Cómo citar este artículo: Muñoz Gómez M, et al. Resumen Estos últimos años han aparecido alertas de seguridad, no siempre bien sustentadas, que cuestionan el uso de algunas alternativas farmacológicas a la transfusión de sangre alogénica y/o lo restringen en indicaciones establecidas. Asistimos también a la preconización de otras alternativas, incluyendo productos hemáticos y fármacos antifibrinolíticos, sin que haya una base científica sólida que lo justifique. Por iniciativa del Grupo de Estudios Multidisciplinares sobre Autotransfusión y del Anemia Working Group España se reunió a un panel multidisciplinar de 23 expertos del área de cuidados de la salud en un foro de debate para: 1) analizar las diferentes alertas de seguridad en torno a ciertas alternativas a la transfusión; 2) estudiar los antecedentes que las han propiciado, la evidencia que las sustentan y las consecuencias que conllevan para la práctica clínica, y 3) emitir una valoración argumentada de la seguridad de cada alternativa a la transfusión cuestionada, según el uso clínico de la misma.Los integrantes del foro mantuvieron contactos por vía telemática y una reunión presencial en la que presentaron y discutieron las conclusiones sobre cada uno de los elementos examinados. Se elaboró un primer documento que fue sometido a 4 rondas de revisión y actualización hasta alcanzar un consenso, unánime en la mayoría de los casos. Presentamos la versión final del documento, aprobada por todos los miembros del panel, esperando sea de utilidad para nuestros colegas. © 2015 Elsevier España, S.L.U. y SEMICYUC. Todos los derechos reservados. Abstract In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. KEYWORDSThe Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use.The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.

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Putting the record straight on aprotinin as safe and effective: Results from a mixed treatment meta-analysis of trials of aprotinin

Abstract: This mixed treatment comparisons meta-analysis demonstrates no increased mortality risk with aprotinin versus other antifibrinolytic agents. All agents were superior to placebo in reducing reexploration for bleeding after adult cardiac surgery.

Cited by 57 publications

References 16 publications

Prevention of Bleeding in Orthognathic Surgery—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Prevention of Bleeding in Orthognathic Surgery—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Comparison between the clot-protecting activity of a mutant plasminogen activator inhibitor-1 with a very long half-life and 6-aminocaproic acid

Foro de debate: seguridad de las alternativas a la transfusión alogénica en el paciente quirúrgico y/o crítico

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