ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 1999 October;40(5):621-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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.