Aprotinin blood transfusion

Royston D, Bidstrup BP, Taylor KM, Sapsford RN. Effect of aprotinin on need for blood transfusion after repeat open-heart surgery. Lancet 1987 2(8571) 1289-91. 

Levy JH, Pifarre R, Schaff HV, Horrow JC, Albus R, Spiess B, Rosengart TK, Murray J, Clark RE, Smith P. A multicenter, double-blind, placebo-controlled trial of aprotinin for reducing blood loss and the requirement for donor-blood transfusion in patients undergoing repeat coronary artery bypass grafting. Circulation 1995 92(8) 2236 4. 

Aprotinin. Aprotinin is a naturally occurring serine protease inhibitor, has found widespread applications either by the intravenous route or as a component of biological sealants, because of its ability to decrease blood loss, and, as a consequence, transfusion requirements. Anaphylactic reactions are mediated by IgG and IgE antibodies. The risk of anaphylactic reactions has been estimated between 0.5 and 5.8% when used intravenously during cardiac surgery, and at 5 for 100,000 applications when used as a biologic sealant [25]. Patients previously treated with this drug present an increased risk and any new administration should be avoided for at least 6 months following an initial exposure [25]. 

MaUett SV, Cox D, Burroughs AK, RoUes K. Aprotinin and reduction of blood loss and transfusion requirements in orthotopic liver transplantation. Lancet 1990 336(8719) 886-7. 

By inhibiting fibrinolysis and preserving platelet function, aprotinin has been shown to reduce blood loss and transfusion requirements in cardiac surgery, lung, and liver transplantations, and surgery for hip replacement. Additional indications are hyperfibrinolytic hemostatic disorders and complications of thrombolytic therapies. In Europe, aprotinin has been in clinical use for about 40 years, but in the United States it has been approved for intravenous applications only since 1993 [M. Kunitz,... 

In a single-center non-randomized study in patients undergoing primary cardiac operations, 3334 were given aprotinin and 3417 were not [203 ]. The former were older, and had more unstable symptoms, lower ejection fractions, more preoperative hemodynamic support, more urgent operations, and more combined coronary or valvular operations. Postoperative bleeding and blood product transfusion were considerably reduced by aprotinin, as was median duration of mechanical ventilation. Aprotinin was not related to postoperative myocardial infarction, renal insufficiency, neurological dysfunction, or operative death. 

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