1.
The use of aprotinin to reduce transfusion requirements in children undergoing cardiac surgery: a meta-analysis
Arnold DM, Fergusson DA, Chan AK, Cook RJ, Fraser GA, Lim W,, et al.,
Blood. 2004;104((11):):742a.. Abstract No. 2718.
2.
Recombinant aprotinin in coronary artery bypass graft operations
Green D, Sanders J, Eiken M, Wong CA, Frederiksen J, Joob A, Palmer A, Trowbridge A, Woodruff B, Moerch M,, et al
Journal of Thoracic & Cardiovascular Surgery. 1995;110((4, Pt 1):):963-70.
Abstract
OBJECTIVE To evaluate the role of recombinant bovine aprotinin in reducing blood loss in coronary artery bypass graft surgery. DESIGN An open-label, randomized, controlled study evaluating two dosage levels of recombinant aprotinin. SETTING Two acute care hospitals (Northwestern Memorial Hospital, Chicago, Ill., and the Scott & White Memorial Hospital, Temple, Texas). PATIENTS Patients undergoing primary and reoperation coronary artery bypass grafting were assigned to groups by means of a computer-generated table of random numbers. Treated (n = 48) and control (n = 36) patients did not differ significantly in age, sex, weight, number of grafts, or preoperative hemoglobin level. INTERVENTIONS Recombinant aprotinin was given at two dosages. Dosage level 1 consisted of a bolus of 2 mg/kg intravenously immediately after the induction of anesthesia, 1 mg/kg added to each liter of the oxygenator prime, and 0.5 mg.kg-1.hr-1 infused continuously during operation. At dosage level 2, doses were doubled. Intraoperative monitoring of anti-factor Xa activity was performed, and additional doses of heparin were given on the basis of anti-factor Xa results. MAIN OUTCOME MEASURES Preoperative and postoperative hemoglobin levels, amounts of autotransfusion device and chest tube drainage blood, and transfusions of allogeneic red blood cells. Adverse clinical events (alterations in renal function, graft thrombosis, myocardial infarction, and death) were recorded. RESULTS Additional heparin was given to 48% patients in the aprotinin group and to 44% of control patients. Overall red blood cell loss (in milliliters, mean +/- standard deviation [SD]) was decreased with aprotinin at dosage level 1 for reoperations (1040 +/- 162 vs 1544 +/- 198, p < 0.01), and at dosage level 2 for all operations (primary operations, 886 +/- 362 vs 1333 +/- 618, p = 0.02; reoperations, 1191 +/- 560 vs 1815 +/- 1116, p = 0.2). Fewer patients in the aprotinin than in the control group had transfusions of donated blood (6/48 vs 12/36, p = 0.02) or reinfusion of chest tube drainage blood (12/48 vs 20/36, p < 0.01). Among patients receiving dosage level 1, there were no myocardial infarctions or deaths. At dosage level 2, one patient had profound bradycardia and died on day 12 and two patients had late graft closures. Two control patients had hypotension after bypass necessitating intraaortic balloon pumps, and one of these patients died. Postoperative increases in blood urea nitrogen and creatinine levels were small in both aprotinin and control groups. No hypersensitivity or other allergic reactions occurred. CONCLUSION We conclude that, at the dosages given, recombinant bovine aprotinin decreases surgical blood loss and transfusion requirements in patients undergoing coronary artery bypass grafting, but its use requires appropriate monitoring of heparin use during bypass. Whether higher dosages of aprotinin increase the risk of graft thrombosis must be further assessed with a larger patient sample.
3.
Recombinant aprotinin in coronary artery bypass graft surgery
Green D, Sanders J, Eiken M, Wong CA, Frederiksen J, Joob A,, et al.,
Blood. 1994;84:238a.. Abstract No. 938.
4.
Aprotinin in coronary bypass surgery reduces blood loss but is associated with an increased risk of vein graft occlusion and clinical thrombotic events
van der Meer J, Hillege HL, Terres W, Ascoop CAPL, Dunselman PHJM, Mulder BJM,, et al.,
British Journal of Haematology. 1994;87((s1):):189. Abstract No. 739.
5.
Tranexamic acid reduces blood loss after cardiopulmonary bypass
Nakashima A, Matsuzaki K, Fukumura F, Hisahara M, Kanegae Y, Fukae K, Miyamoto K, Nishida T, Tokunaga S, Tominaga R,, et al
ASAIO Journal. 1993;39((3):):M185-9.
Abstract
To evaluate the effect of tranexamic acid (TA) on blood loss after cardiopulmonary bypass (CPB), 157 patients who underwent elective valve replacement operations were studied, with one group of 90 patients receiving tranexamic acid (Group TA) and 67 patients serving as the control group (Group N). In group TA, 50 mg/kg of tranexamic acid was administered just before and after CPB, and every 90 minutes during CPB. The activated coagulation time was maintained at more than 450 seconds during CPB in both groups. There was no significant difference in the CPB time between the groups (163 +/- 32 min in group N and 152 +/- 38 min in group TA:NS). The time required for hemostasis was shortened in group TA, which resulted in a shorter operation time (6.7 +/- 1.5 hrs vs 6.0 +/- 1.5 hrs in group N and group TA, respectively: p = 0.006). The amount of chest tube drainage within 12 hours after surgery was significantly reduced (225 +/- 129 ml vs. 180 +/- 118 ml in group N and group TA, respectively: p = 0.026). The chest tube was able to be removed earlier in group TA, and the total blood loss was significantly smaller in group TA (402 +/- 292 ml) than in group N (631 +/- 609 ml; p = 0.004). The authors thus conclude that antifibrinolytic therapy during CPB with tranexamic acid reduces postoperative blood loss, and shortens the operation time due to an improvement in hemostasis.
6.
Aprotinin in cardiosurgery: a randomized prospective study with different protocols for use Italian
Locatelli A, Bertollo D, Bianchi T, Bellinzona G, Ceriana P, Chiaudani G, Cadregari F, Garofalo M, Mazza MP, Maurelli M,, et al
Minerva Anestesiologica. 1990;56((9):):973-5.
7.
Lack of effect of tranexamic acid on rheumatoid arthritis
Rasmussen GG, Brandslund I, Urfe P, Teisner B, Siersted HC, Hindersson P, Lund HI, Nielsen EF, Arfelt E, Jensen A,, et al
Scandinavian Journal of Rheumatology. 1984;13((4):):369-73.
Abstract
In a double-blind controlled study on 45 rheumatoid arthritis patients, no effect of tranexamic acid (Cyklocapron, 4.5 g per day for 6 weeks) was found in terms of subjective or objective parameters of disease activity. Tranexamic acid did not reduce complement activation, measured by plasma concentrations of the complement C3 split product C3d. Immune complex concentrations in serum were also unaffected. We conclude that plasmin inhibitors do not reduce immune complex mediated complement activation, and they should not be used for treatment of rheumatoid arthritis.