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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC PAPERS
The Journal of Cardiovascular Surgery 1999 Ottobre;40(5):621-6
The use of micro-dose aprotinin with continuous infusion in coronary artery bypass surgery
Holmes J. H., Jones M. F.*, Anderson R. P.**, Knopes K. D.*, Guyton S. W.**, Hall R. A.**
From the Departments of General Surgery * Anesthesiology and ** Cardiothoracic Surgery Virginia Mason Medical Center, Seattle WA, USA
Background. To evaluate the efficacy of aprotinin at a dose far less than standard.
Methods. Experimental design: Retrospective, case-control study. Setting: community-based, teaching hospital. Patients: one hundred one patients undergoing primary, non-emergent, coronary artery bypass during two, six-month periods were studied. Interventions: during the first period aprotinin was not administered, and these patients served as controls (n=52). During the second period all patients received aprotinin via a micro-dose regimen (n=49). Measures: postoperative bleeding and blood product usage served as determinants of efficacy.
Results. A significant difference existed in postoperative bleeding with the mean thoracic drain outputs being reduced in the aprotinin group both at 6 hours (p=0.0003) and in total (p=0.0004). This was further supported by significantly higher hematocrits (p=0.03) on the first postoperative day in patients receiving aprotinin. Likewise, there was a significant reduction in total blood product exposures (p=0.04) and platelet usage (p=0.02) in the aprotinin group with a tendency towards decreased red cell usage. Further, when all patients with a hematocrit ≤30% prior to bypass were excluded, the significant reduction in total blood product exposures persisted (p=0.04), and there was a significant reduction in red cell usage (p=0.04) with a trend towards decreased platelet usage (p=0.06) in the aprotinin group.
Conclusions. Micro-dose aprotinin significantly reduces postoperative bleeding and blood product usage in primary, non-emergent, CABG patients.