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Thorac Cardiovasc Surg 2009; 57(8): 455-459
DOI: 10.1055/s-0029-1186067
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Aprotinin-Associated Risks in Off-Pump Coronary Artery Bypass Grafting[*]

H. B. Bittner1 , M. Lange1 , J. Lemke1 , A. Rastan1 , F. W. Mohr1
  • 1Cardiovascular and Thoracic Surgery, Heart Center Leipzig, Leipzig, Germany
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Publikationsverlauf

received January 31, 2009

Publikationsdatum:
14. Dezember 2009 (online)

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Abstract

Background: Little data is available regarding the safety of using the serine protease inhibitor aprotinin in off-pump cardiac surgery. We retrospectively assessed the risks of administering the drug to adult patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: Aprotinin was administered as a bolus of 1 or 2 million kallikrein inhibiting units to 391 patients following median sternotomy; 370 control patients underwent surgery during the same time period without receiving aprotinin. No other antifibrinolytic agents were administered. Results: Preoperative characteristics, length of ICU and hospital stay were similar between the mostly medium-risk aprotinin and the control patients. Postoperative cardiac, renal, neurological, and respiratory complications and hospital mortality occurred with comparable frequencies in both groups. Levels of myocardial enzymes during the first 72 h after surgery also did not differ significantly. Conclusion: Use of aprotinin in OPCABG was not associated with a higher incidence of hospital mortality, cardiovascular, renal, or other complications. Given the good safety profile in this large patient population we suggest that aprotinin could still be a valid antifibrinolytic treatment option in OPCABG.

Key words

antifibrinolytic treatment - aprotinin - complications - off‐pump coronary artery bypass grafting - safety

1 Presented in part at the 36th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, Hamburg, February 11–14, 2007.

References

  • 1 Sedrakyan A, Treasure T, Elefteriades J A. Effect of aprotinin on clinical outcomes in coronary artery bypass graft surgery: a systematic review and meta-analysis of randomized clinical trials.  J Thorac Cardiovasc Surg. 2004;  128 442-448
    CrossrefPubMedGoogle Scholar
  • 2 Henry D A, Carless P A, Moxey A J et al. Anti-fibrinolytic use for minimizing perioperative allogeneic blood transfusion.  Cochrane Database Syst Rev. 2007;  (4) CD001886 DOI: 10.1002/14651858.CD001886.pub2
    PubMedGoogle Scholar
  • 3 Englberger L, Markart P, Eckstein F S, Immer F F, Berdat P A, Carrel T P. Aprotinin reduces blood loss in off-pump coronary artery bypass (OPCAB) surgery.  Eur J Cardiothorac Surg. 2002;  22 545-551
    CrossrefPubMedGoogle Scholar
  • 4 Vanek T, Jares M, Fajt R et al. Fibrinolytic inhibitors in off-pump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo).  Eur J Cardiothorac Surg. 2005;  28 563-568
    CrossrefPubMedGoogle Scholar
  • 5 Poston R S, White C, Gu J et al. Aprotinin shows both hemostatic and antithrombotic effects during off-pump coronary artery bypass grafting.  Ann Thorac Surg. 2006;  81 104-111
    CrossrefPubMedGoogle Scholar
  • 6 Bittner H B, Lange M, Lemke J, Rastan A, Mohr F W. The impact of aprotinin on blood loss and blood transfusion in off-pump coronary artery bypass grafting.  Ann Thorac Surg. 2008;  85 1662-1668
    CrossrefPubMedGoogle Scholar
  • 7 Mangano D T, Tudor J C, Dietzel C. The risk associated with aprotinin in cardiac surgery.  New Eng J Med. 2006;  354 353-365
    CrossrefPubMedGoogle Scholar
  • 8 Mangano D T, Miao Y, Vuylsteke A et al. Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery.  JAMA. 2007;  297 471-479
    CrossrefPubMedGoogle Scholar
  • 9 Ferraris V A, Bridges C R, Anderson R P. Aprotinin in cardiac surgery.  N Engl J Med. 2006;  354 1953-1954
    CrossrefPubMedGoogle Scholar
  • 10 Sedrakyan A, Atkins D, Treasure T. The risk of aprotinin: a conflict of evidence.  Lancet. 2006;  367 1376-1377
    CrossrefPubMedGoogle Scholar
  • 11 Royston D, Chhatwani A. Safety aspects of aprotinin therapy in cardiac surgery patients.  Expert Opin Drug Saf. 2006;  5 539-552
    CrossrefPubMedGoogle Scholar
  • 12 Mouton R, Finch D, Davies I, Binks A, Zacharowski K. Effect of aprotinin on renal dysfunction in patients undergoing on-pump and off-pump cardiac surgery: a retrospective observational study.  Lancet. 2008;  371 475-482
    CrossrefPubMedGoogle Scholar
  • 13 Pagano D, Howell N J, Freemantle N et al. Bleeding in cardiac surgery: the use of aprotinin does not affect survival.  J Thorac Cardiovasc Surg. 2008;  135 495-502
    CrossrefPubMedGoogle Scholar
  • 14 Fergusson D A, Hébert P C, Mazer C D et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery.  New Engl J Med. 2008;  358 2319-2331
    CrossrefPubMedGoogle Scholar
  • 15 Dietrich W, Ebell A, Busley R, Boulesteix A-L. Aprotinin and anaphylaxis: analysis of 12403 exposures to aprotinin in cardiac surgery.  Ann Thorac Surg. 2007;  84 1144-1150
    CrossrefPubMedGoogle Scholar
  • 16 Levey A S, Greene T, Kusek J W, Beck G L. MDRD Study Group . A simplified equation to predict glomerular filtration rate from serum creatinine.  J Am Soc Nephrol. 2000;  11 A0828
    PubMedGoogle Scholar
  • 17 Alderman E L, Levy J H, Rich J B et al. Analyses of coronary graft patency after aprotinin use: results from the International Multicenter Aprotinin Graft Patency Experience (IMAGE) trial.  J Thorac Cardiovasc Surg. 1998;  116 716-730
    CrossrefPubMedGoogle Scholar
  • 18 Poston R S, Gu J, White C et al. Perioperative management of aspirin resistance after off-pump coronary artery bypass grafting: possible role for aprotinin.  Transfusion. 2008;  48 39S-46S
    CrossrefPubMedGoogle Scholar
  • 19 Sear J W. Kidney dysfunction in the postoperative period.  Br J Anaesth. 2005;  95 20-32
    CrossrefPubMedGoogle Scholar
  • 20 Chertow G M, Lazarus J M, Christiansen C L et al. Preoperative renal risk stratification.  Circulation. 1997;  95 878-884
    CrossrefPubMedGoogle Scholar
  • 21 Godet G, Fléron M-H, Vicaut E et al. Risk factors for acute postoperative renal failure in thoracic or thoracoabdominal aortic surgery: a prospective study.  Anesth Analg. 1997;  85 1227-1232
    CrossrefPubMedGoogle Scholar
  • 22 Conlon P J, Stafford-Smith M, White W D et al. Acute renal failure following cardiac surgery.  Nephrol Dial Transplant. 1999;  14 1158-1162
    CrossrefPubMedGoogle Scholar
  • 23 O'Connor C J, Brown D V, Avramov M, Barnes S, O'Connor H N, Tuman K J. The impact of renal dysfunction on aprotinin pharmacokinetics during cardiopulmonary bypass.  Anesth Analg. 1999;  89 1101-1107
    PubMedGoogle Scholar
  • 24 Sedrakyan A, Wu A W, Parashar A, Bass E B, Treasure T. Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting. A meta-analysis of systematically reviewed trials.  Stroke. 2006;  37 2759-2769
    CrossrefPubMedGoogle Scholar

1 Presented in part at the 36th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, Hamburg, February 11–14, 2007.

Dr. MD, PhD Hartmuth B. Bittner

Heart Center Leipzig

Struempellstr. 39

04289 Leipzig

Germany

Telefon: + 493418651422

Fax: + 493418651452

eMail: heartbeatgermany@aol.com

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