Aprotinin in elective primary bypass surgery. Graft patency and clinical efficacy

• Published in: European journal of cardio-thoracic surgery Vol. 9; no. 4; pp. 206 - 210
• Main Authors: LASS, M, WELZ, A, KOCHS, M, MAYER, G, SCHWANDT, M, HANNEKUM, A
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 1995; Elsevier Science
• Subjects: Aged; Aprotinin - adverse effects; Aprotinin - therapeutic use; Biological and medical sciences; Blood Loss, Surgical - prevention & control; Blood Transfusion; Blood. Blood coagulation. Reticuloendothelial system; Chi-Square Distribution; Coronary Angiography; Coronary Artery Bypass; Coronary Disease - diagnostic imaging; Coronary Disease - surgery; Double-Blind Method; Graft Occlusion, Vascular - chemically induced; Graft Occlusion, Vascular - diagnostic imaging; Humans; Intraoperative Care; Male; Medical sciences; Pharmacology. Drug treatments; Vascular Patency - drug effects; Human; Homograft; Controlled therapeutic trial; Antifibrinolytic; Graft surgical; Coronary artery
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(05)80146-0

The proteinase inhibitor aprotinin is used in open heart surgery toreduce intraoperative and postoperative blood loss and transfusionrequirements. To investigate a possible influence on graft patency, arandomized double-blind group comparison study was carried out in malepatients elected for primary bypass surgery. One hundred ten (55/55)patients received either placebo treatment or aprotinin according to theHammersmith scheme (2 Mio KIU as loading dose before sternotomy, followedby an infusion of 0.5 Mio KIU/h until the end of surgery; 2 Mio KIU addedto the priming volume additionally). Graft patency was evaluated byangiography in 44 aprotinin and 35 placebo patients between the 18th and35th days postoperatively. There was no difference in the overall graftocclusion: in the aprotinin group 89.5% (111/124) grafts were found patentcompared to 87.2% (89/102) in the placebo group. Of the aprotinin patients72.7% (32/44) and 71.4% (25/35) of the placebo patients had all graftspatent. Venous grafts were occluded in 16% (7/44) of aprotinin patients andin 29% (10/35) of placebo patients. On the other hand 5/27 patients in theaprotinin group vs 0/27 in the placebo group had occluded internal mammaryartery (IMA) grafts (P = 0.0511%). Graft occlusions were not accompanied bysigns of myocardial infarction in any case. Fifty-one patients in theaprotinin group and 47 patients in the placebo group were valid forparameters of clinical efficacy: blood loss within 6 h postoperatively wasreduced by 58.5% in the aprotinin group (P ≪ 0.001).(ABSTRACT TRUNCATEDAT 250 WORDS)