Aprotinin reduces blood loss in off-pump coronary artery bypass (OPCAB) surgery

Englberger, L.; Markart, P.; Eckstein, F.S.; Immer, F.F.; Berdat, P.A.; Carrel, T.P. (2002). Aprotinin reduces blood loss in off-pump coronary artery bypass (OPCAB) surgery. European journal of cardio-thoracic surgery, 22(4), pp. 545-551. Elsevier Science B.V. 10.1016/S1010-7940(02)00433-5

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Objective: Effects of aprotinin in off-pump coronary artery bypass (OPCAB) surgery have not yet been described. This study analyses hemostasiologic changes and potential benefit in OPCAB patients treated with aprotinin. Methods: In a prospective, double-blind, randomized study 47 patients undergoing OPCAB surgery were investigated. Patients received either aprotinin (2×10 superscript 6 KIU loading dose and 0.5×10 superscript 6 KIU/h during surgery, n=22) or saline solution (control, n=25). Activated clotting time was adjusted to a target of 250 s intraoperatively. Blood samples were taken up to 18 h postoperatively: complete hematologic and hemostasiologic parameters including fibrinopeptide A (FPA) and D-dimer in a subgroup of 31 patients were analyzed. Blood loss, blood transfusion and other clinical data were collected. Results: Both groups showed comparable demographic and intraoperative variables. Forty-one (87%) patients of the whole study group received aspirin within 7 days prior to surgery. Number of grafts per patient were comparable (2.9±1.0 [mean±SD] in the aprotinin group and 2.8±1.2 in control, P=0.83). Blood loss during the first 18 h in intensive care unit was significantly reduced in patients treated with aprotinin (median [25th–75th percentiles]: 500 [395–755] ml vs. 930 [800–1170] ml, P<0.001). Postoperatively only two patients (10%) in the aprotinin group received packed red blood cells, whereas eight (35%) in the control group (P=0.07). Perioperatively FPA levels reflecting thrombin generation were elevated in both groups. The increase in D-dimer levels after surgery was significantly inhibited in the aprotinin group (P<0.001). Early clinical outcome was similar in both groups. Conclusions: Aprotinin significantly reduces blood loss in patients undergoing OPCAB surgery. Inhibition of enhanced fibrinolysis can be observed. FPA generation during and after OPCAB surgery seems not to be influenced by aprotinin.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Englberger, Lars; Eckstein, Friedrich Stefan; Immer, Franz; Berdat, Pascal and Carrel, Thierry

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1010-7940

Publisher:

Elsevier Science B.V.

Language:

English

Submitter:

Marceline Brodmann

Date Deposited:

05 Oct 2020 09:56

Last Modified:

05 Oct 2020 09:56

Publisher DOI:

10.1016/S1010-7940(02)00433-5

BORIS DOI:

10.7892/boris.115409

URI:

https://boris.unibe.ch/id/eprint/115409

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