Aprotinin in cardiac surgery: a different point of view

Immer, Franz F; Jent, Philipp; Englberger, Lars; Stalder, Mario; Gygax, Erich; Carrel, Thierry P; Tevaearai, Hendrik T (2008). Aprotinin in cardiac surgery: a different point of view. Heart surgery forum, 11(1), E9-12. Charlottesville, Va.: Forum Multimedia Pub. 10.1532/HSF98.20071149

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Aprotinin is widely used in cardiac surgery to reduce postoperative bleeding and the need for blood transfusion. Controversy exists regarding the influence of aprotinin on renal function and its effect on the incidence of perioperative myocardial infarction (MI) and cerebrovascular incidents (CVI). In the present study, we analyzed the incidence of these adverse events in patients who underwent coronary artery bypass grafting (CABG) surgery under full-dose aprotinin and compared the data with those recently reported by Mangano et al [2006]. For 751 consecutive patients undergoing CABG surgery under full-dose aprotinin (>4 million kalikrein-inhibitor units) we analyzed in-hospital data on renal dysfunction or failure, MI (defined as creatine kinase-myocardial band > 60 iU/L), and CVI (defined as persistent or transient neurological symptoms and/or positive computed tomographic scan). Average age was 67.0 +/- 9.9 years, and patient pre- and perioperative characteristics were similar to those in the Society of Thoracic Surgeons database. The mortality (2.8%) and incidence of renal failure (5.2%) ranged within the reported results. The incidence rates of MI (8% versus 16%; P < .01) and CVI (2% versus 6%; P < .01) however, were significantly lower than those reported by Mangano et al. Thus the data of our single center experience do not confirm the recently reported negative effect of full-dose aprotinin on the incidence of MI and CVI. Therefore, aprotinin may still remain a valid option to reduce postoperative bleeding, especially because of the increased use of aggressive fibrinolytic therapy following percutaneous transluminal coronary angioplasty.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology 04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery
UniBE Contributor:	Immer, Franz Ferdinand, Jent, Philipp, Englberger, Lars, Stalder, Mario, Carrel, Thierry, Tevaearai, Hendrik
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1098-3511
ISBN:	18270146
Publisher:	Forum Multimedia Pub.
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 15:05
Last Modified:	27 Feb 2024 14:29
Publisher DOI:	10.1532/HSF98.20071149
PubMed ID:	18270146
Web of Science ID:	000256425500003
URI:	https://boris.unibe.ch/id/eprint/28291 (FactScience: 119566)