Document Detail


Low-dose postoperative aprotinin reduces mediastinal drainage and blood product use in patients undergoing primary coronary artery bypass grafting who are taking aspirin: a prospective, randomized, double-blind, placebo-controlled trial.
MedLine Citation:
PMID:  11547294     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although low-dose aprotinin administered after cardiopulmonary bypass has been reported to reduce mediastinal blood loss and blood product requirements in patients not taking aspirin, it is unknown whether low-dose postoperative aprotinin has any beneficial effects in patients undergoing coronary artery bypass operations who are at high risk of excessive postoperative bleeding and increased transfusion requirements because of aspirin use until just before the operation. METHODS: Fifty-five patients undergoing primary coronary artery operations with cardiopulmonary bypass who continued taking aspirin (150 mg/d) until the day before the operation were enrolled in a prospective, randomized, double-blind trial to receive a single dose of either placebo (n = 29) or 2 x 10(6) kallikrein inhibiting units of aprotinin (n = 26) at the time of sternal skin closure. RESULTS: Patients in the aprotinin group had a lower rate (28 +/- 18 vs 43 +/- 21 mL/h [mean +/- standard deviation], P <.005) and total volume of mediastinal drainage (955 +/- 615 vs 1570 +/- 955 mL, P <.007), as well as a shorter duration of mediastinal drain tube insertion (24.4 +/- 13.8 vs 31.3 +/- 16.5 hours, P <.05). In addition, a smaller proportion of patients receiving aprotinin required a blood product (31% vs 62%, P =.03), resulting in a reduction in the use of packed cells by 47% (P =.05), platelets by 77% (P =.01), fresh frozen plasma by 88% (P =.03), and total blood products by 68% (P =.01) in this group. CONCLUSIONS: These results suggest that postoperative administration of low-dose aprotinin in patients taking aspirin until just before primary coronary artery operations with cardiopulmonary bypass not only reduces the rate and total amount of postoperative mediastinal blood loss but also lowers postoperative blood product use.
Authors:
J M Alvarez; L R Jackson; C Chatwin; J J Smolich
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  122     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-09-07     Completed Date:  2001-10-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  457-63     Citation Subset:  AIM; IM    
Affiliation:
Cardiothoracic Surgery Unit, Monash Medical Centre, Department of Medicine, Monash University, Clayton, Victoria, Australia. john.alvarez@health.wa.gov.au
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MeSH Terms
Descriptor/Qualifier:
Aged
Aprotinin / therapeutic use*
Aspirin / adverse effects*
Blood Component Transfusion / statistics & numerical data*
Combined Modality Therapy
Coronary Artery Bypass / adverse effects*
Coronary Disease / drug therapy*,  surgery*
Double-Blind Method
Drainage
Female
Hemoglobins / analysis
Hemostatics / therapeutic use*
Humans
Infusions, Intravenous
Male
Mediastinum*
Middle Aged
Platelet Aggregation Inhibitors / adverse effects*
Postoperative Care / methods*
Postoperative Hemorrhage / blood,  etiology*,  prevention & control*
Prospective Studies
Time Factors
Chemical
Reg. No./Substance:
0/Hemoglobins; 0/Hemostatics; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 9087-70-1/Aprotinin

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


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