Aprotinin renal function

Aprotinin administration during surgery should follow heparin treatment to avoid any risk. Patients under the treatment of antifibrinolytic therapy should be treated cautiously when coadministering drugs affecting hemostasis and estrogens.229 Accumulation of albumin may occur in patients with impaired renal function if large volumes of albumin solutions are administered. 

Studies showing renal impairment In a systematic review of 11 studies, including 10 that studied renal function and seven that studied deaths, aprotinin w os associated with renal dysfunction (risk ratio, RR — 1.42 95% Cl = 1.13, 1.79) and long-term mortality (HR = 1.22 95% Cl = 1.08, 1.39) [196 ]. Pooled estimates were lower for short-term mortality (RR = 1.16 95% Cl — 0.84, 1.58) and renal failure requiring dialysis (RR = 1.17 95% Cl = 0.99, 1.38). Time on bypass was a significant source of heterogeneity, with a 29% increased risk of renal dysfunction for every 10-minute increase in bypass time. 

In a matched cohort study, in which 200 patients who received high-dose aprotinin were compared with 200 age- and sex-matched patients who received tranexamic acid during primary isolated coronary surgery, there were no significant differences in fractional change in creatinine clearance or any other assessments of postoperative renal function between the two groups [202 ]. Adverse events rates were also similar for early mortality (3.5% versus 4.5%), stroke... 

In a placebo-controlled study of 26 neonates who underwent cardiac surgery, aprotinin was not efficacious and had no deleterious effect on renal function the authors suggested that it is unclear whether adverse reactions data on aprotinin from studies in adults are relevant to neonates [204 ]. Similarly, in a controlled study in 31 patients who underwent neuromuscular scoliosis surgery, aprotinin reduced total blood loss and did not cause renal impairment. However, these studies were too small to draw any conclusions. 

Conclusions On the whole, although not exclusively, the positive associations of aprotinin with impaired renal function have come from systematic reviews and large randomized studies, while the negative studies have tended to be small or retrospective. 

Kher A, Meldrum KK, Hile KL, Wang M, Tsai BM, Turrentine MW, et al. Aprotinin improves kidney function and decreases tubular cell apoptosis and proapoptotic signaling after renal ischemia-reperfusion. J Thorac Cardiovasc Surg 2005 130 662-669. 

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