Postoperative cardiac aprotinin

Cicek S, Demirkilic U, Ozal E, Kuralay E, Bingol H, Tatar H, Ozturk OY. Postoperative use of aprotinin in cardiac operations an alternative to its prophylactic use. J Thorac Cardiovasc Surg 1996 112(6) 1462-7. 

In a non-randomized study, 391 patients who were given aprotinin after median sternotomy for non-bypass surgery were compared with 370 controls postoperative cardiac, renal, neurological, and respiratory complications and hospital mortality were similar in the two groups [20E]. 

In a non-randomized prospective study of 1188 patients who underwent cardiac surgery, the first 596 received aprotinin and the next 592 received tranexamic acid [198 ]. Postoperatively, in those who underwent primary valve surgery, tranexamic acid was associated with significantly higher incidences of seizures (4.6% versus 1.2%), persistent atrial fibrillation (7.9% versus 2.3%), and renal insufficiency (9.7% versus 1.7%). In those who underwent primary... 

In a follow-up database study of 3535 patients who underwent cardiac surgery, 635 were treated with aprotinin and 2900 with tranexamic acid. Those who received aprotinin had an increased risk of postoperative dialysis (adjusted RR = 1.76 95% Cl = 1.15, 2.70) [199 ]. 

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. 

In a retrospective survey of 200 neonates scheduled for palliative or corrective congenital cardiac surgery requiring cardiopulmonary bypass, 156 were given aprotinin and 44 were not [205 ]. There was more renal dysfunction in those who received aprotinin, although the difference was not statistically significant. Time on bypass and age were significant predictors of postoperative renal dysfunction irrespective of the use of aprotinin. 

---