Document Detail


Evaluating the safety implications of aprotinin use: the Retrospective Evaluation of Aprotinin in Cardio Thoracic Surgery (REACTS).
MedLine Citation:
PMID:  17532955     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Aprotinin is a drug used to reduce bleeding in patients undergoing cardiothoracic surgery with cardiopulmonary bypass. A recent cohort evaluation found elevated risks of renal, cardiovascular, and cerebrovascular events when aprotinin was used. We sought to determine the impact of aprotinin on safety variables among patients receiving cardiothoracic surgery with cardiopulmonary bypass from a single US hospital that reserves aprotinin for complex surgeries and Jehovah's Witnesses and does not utilize celite-based activated clotting time determinations. METHODS: We performed a cohort evaluation with multivariate logistic regression, including propensity score adjustment comprising patients from January 1, 2000 and December 31, 2005. We evaluated 3348 patients having cardiothoracic surgery in a single tertiary care medical center. We observed aprotinin use or lack of aprotinin in cardiothoracic surgery. The main outcome measures were odds (expressed as an odds ratio with 95% confidence interval) of developing myocardial infarction, cerebrovascular events, and renal dysfunction after cardiothoracic surgery between groups. RESULTS: Patients receiving aprotinin were less likely to experience a cerebrovascular event compared with control [0.65 (0.46-0.91)] and did not have an elevated odds of myocardial infarction [1.04 (0.53-2.04)] but were more likely to experience postoperative renal dysfunction [2.03 (1.37-3.01)]. CONCLUSIONS: Aprotinin was not associated with negative myocardial or cerebrovascular risks but did increase the risk of renal dysfunction. It is not known whether the renal dysfunction reflects renal damage or a transient reduction in glomerular filtration pressure.
Authors:
Craig I Coleman; Vera T Rigali; Jonathan Hammond; Jeffrey Kluger; Kenneth W Jeleniowski; C Michael White
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  133     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-29     Completed Date:  2007-06-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1547-52     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Hartford Hospital, Hartford, Conn 06102-5037, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aprotinin / adverse effects*
Blood Loss, Surgical / prevention & control*
Cardiopulmonary Bypass
Cardiovascular Surgical Procedures*
Chi-Square Distribution
Female
Hemostatics / adverse effects*
Humans
Kidney Diseases / chemically induced*
Logistic Models
Male
Retrospective Studies
Thoracic Surgical Procedures*
Chemical
Reg. No./Substance:
0/Hemostatics; 9087-70-1/Aprotinin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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