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Does use of aprotinin decrease the incidence of stroke and neurological complications in adult patients undergoing cardiac surgery?
MedLine Citation:
PMID:  17670709     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether aprotinin use was associated with a lower incidence of stroke and neurological complications in adult patients undergoing cardiac surgery. Using the reported search 224 papers were identified on Medline, 722 on Embase and 12 by hand-searching reference lists. Eight papers represented the best evidence on the subject and the author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated. We conclude that there is evidence from three meta-analyses and two more recent RCTs that the use of aprotinin is associated with a decreased incidence of stroke and neurological complications in some patients undergoing cardiac surgery. However, many single studies within these meta-analyses are small and designed to look at other outcomes so are underpowered for neurological outcome. In contrast, however, a recent cohort study has raised concerns about aprotinin, suggesting that its use is associated with a significant increased risk of stroke in uncomplicated CABG surgery. Ideally further large well-constructed RCTs are required to give a definitive answer to this question and determine the most appropriate dose but given recent concerns, data may have to be obtained from large better controlled cohort studies.
Authors:
Andrew Ronald; Joel Dunning
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Publication Detail:
Type:  Journal Article     Date:  2006-08-15
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  5     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2007-08-02     Completed Date:  2007-08-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  767-73     Citation Subset:  -    
Affiliation:
Department of Cardiac Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK. alronald@tiscali.co.uk
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