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.
Journal of Cardiovascular Surgery 40(5): 621-626
1999
ISSN/ISBN: 0021-9509 PMID: 10596992 Document Number: 501006
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 ltoreq30% 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.