Comparison of two doses of aprotinin in patients receiving aspirin before coronary bypass surgery

Abstract

This study was designed to evaluate efficacy and tolerability of two different doses of aprotinin in patients receiving aspirin before undergoing coronary artery bypass grafting. Forty-two patients were randomized to receive either placebo (group I), or aprotinin in doses of 4 000 000 KIU (group II) or 6 000 000 KIU (group III). Drug efficacy was determined by measuring postoperative blood loss and transfusion of blood products. Both doses were effective in reducing blood loss and transfusion requirements. Blood loss through thoracotomy drainage was 450 ± 224, 182 ± 144, 142 ± 98 ml, respectively, for control and treatment groups II and III (p = 0.0001). The numbers of patients with blood transfusions were seven (50%), two (17%) and two (17%) for group I and treatment groups II and III, respectively (p = 0.10). Tolerability was excellent and complications few and reversible.

In conclusion, high and medium doses of aprotinin were well tolerated and reduced bleeding and transfusion requirements in patients submitted to coronary bypass surgery under the effects of aspirin.

Get full access to this article

View all access options for this article.

References

Harker LA , Malpass TW , Branson HE , Hessel EA , Slichter SJ. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: acquired transient platelet dysfunction associated with selective alpha granule release . Blood 1980; 56: 824-834 .

Harker LA. Bleeding after cardiopulmonary bypass . N Engl J Med 1986; 314: 1446-1448 .

Bidstrup BP , Royston D , Sapsford RN , Taylor KM. Reduction in blood loss and blood use after cardiopulmonary bypass with high dose aprotinin (Trasylol) . J Thorac Cardiovasc Surg 1989; 97: 364-372 .

Alajmo F , Calamai G , Perna AM et al. High-dose aprotinin: hemostatic effects in open heart operations . Ann Thorac Surg 1989; 48: 536-539 .

Dietrich W , Spannagl M , Jochum M et al. Influence of high-dose aprotinin treatment on blood loss and coagulation patterns in patients undergoing myocardial revascularization . Anesthesiology 1990; 73: 1119-1126 .

Bidstrup BP , Royston D , McGuiness C , Sapsford RN. Aprotinin in aspirin-pretreated patients . Perfusion 1990; 5: 77-81 .

Patrono C , Ciabattoni G , Pinca E et al. Low dose aspirin and inhibition of thromboxane B2 production in healthy subjects . Thromb Res 1980; 17: 317-327 .

Michelson E , Morganroth J , Torosian M , Macvaugh H. Relation of perioperative use of aspirin to increased mediastinal blood loss after coronary artery bypass surgery . J Thorac Cardiovasc Surg 1978; 76: 694-697 .

Ferraris VA , Ferraris SP , Lough FC , Betty W. Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting . Ann Thorac Surg 1988; 45: 71-74 .

10.

Sethi GK , Copeland JG , Goldman S et al. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting . J Am Coll Cardiol 1990; 15: 15-20 .

11.

Van Oeveren W , Janssen NJ , Bidstrup BP et al. Effects of aprotinin on hemostatic mechanisms during cardiopulmonary bypass . Ann Thorac Surg 1987; 44: 640-645 .

12.

Blauhut LB , Gross C , Necek S et al. Effects of high-dose aprotinin on blood loss, platelet function, fibrinolysis, complement, and renal function after cardiopulmonary bypass . J Thorac Cardiovasc Surg 1991; 101: 958-967 .

13.

Royston D , Bidstrup BP , Taylor KM , Sapsford RN. Effect of aprotinin on need for blood transfusion after repeat open-heart surgery . Lancet 1987; II: 1289-1291 .

14.

Bidstrup BP , Royston D , Taylor KM , Sapsford RN. Effect of aprotinin on need for blood transfusion in patients with septic endocarditis having open heart surgery . Lancet 1988; 1: 366-367 .

15.

Van Oeveren W , Harder MP , Roozendaal KJ , Eijman L , Wildevuur CRJ. Aprotinin protects platelets against the initial effect of cardiopulmonary bypass . J Thorac Cardiovasc Surg 1990; 99: 788-797 .

16.

Lemmer JH , Dilling EW , Morton JR et al. Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens . Ann Thorac Surg 1996; 62: 1659-1668 .

17.

Cosgrove DM , Heric B , Lytle BW et al. Aprotinin therapy for reoperative myocardial revascularization: a placebo-controlled study . Ann Thorac Surg 1992; 54: 1031-1038 .

18.

Murkin JM , Lux JA , Shannon NA et al. Aprotinin significantly decreases bleeding and transfusion requirements in patients receiving aspirin and undergoing cardiac operations . J Thorac Cardiovasc Surg 1994; 107: 554-561 .

19.

Umbrain V , Christiaens F , Camu F.

Intraoperative coronary thrombosis: can aprotinin and protamine be incriminated?

J Cardiothorac Vasc Anesth 1994; 8: 198-201 .