Aprotinin tranexamic acid

Pharmacological inhibition of the key enzymes responsible for the consecutive activation of cascade of reactions, including aprotinin, tranexamic acid, aminocapron acid, Cl-esterase inhibitor, antioxidants, and free radical scavengers are also under evaluation to improve hemocompatibility. Research into the modification of surfaces with integrin (receptors that link cellular components to extracellular matrix proteins) fragments, such as peptides with RGD amino acid sequence, has been conducted to increase hemocompatibility and biocompatibility. Further research into the improvement of device... 

Inactivation of the fibrinolytic system can be achieved by plasmin inhibitors, such as -aminocaproic acid, p-aminomethylbenzoic acid (PAMBA), tranexamic acid, and aprotinin, which also inhibits other proteases. 

Barrens RW, Jahr JS. A review of rost-cardiopulmonary bypass bleeding, aminocaproic acid, tranexamic acid, and aprotinin. Am J Ther 1996 3(12) 821-38. 

In acute promyeloc i ic leukaemia the combination of tretinoin and antifibrinol i ics such as tranexamic acid and aprotinin has been associated with fatal thrombotic complications. 

Further reports have appeared, many being comparisons between aprotinin and either tranexamic acid or aminocaproic acid. The results have been conflicting. 

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 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... 

Death In a double-blind, randomized, placebo-controlled trial, 298 patients scheduled for low- or intermediate-risk firsttime cardiac surgery with cardiopulmonary bypass were randomized to tranexamic acid, high-dose aprotinin, or placebo. Neither antifibrinolytic agent increased the incidence of death [209 ]. However, a meta-analysis, updated in the light of these data, still showed increased mortality attributable to aprotinin (OR = 1.50 95% Cl = 1.04, 2.27) piO ]. 

Later AF, Maas JJ, Engbers FH, Versteegh MI, Bruggemans EF, Dion RA, Klautz RJ. Tranexamic acid and aprotinin in low- and intermediate-risk cardiac surgery a non-sponsored, double-blind, randomised, placebo-controlled trial. Eur J Cardiothorac Surg 2009 36(2) 322-9. 

Brown JR. Mortality manifesto a metaanalysis of aprotinin and tranexamic acid mortality. Eur J Cardiothorac Surg 2009 36(4) 781-2. 

Furst, W., Banerjee, A., Redl, H. Comparison of structure, strength and cytocompatibility of a fibrin matrix supplemented either with tranexamic acid or aprotinin. J. Biomed. Mater. Res. B Appl. Biomater. 82(1), 109-114 (2007)... 

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