Effect of intraoperative aprotinin administration on postoperative bleeding in patients undergoing cardiopulmonary bypass operation.
To study the hemostyptic effect of aprotinin (Trasylol) in patients undergoing extracorporeal circulation for coronary artery bypass operations, we randomized 12 of 24 patients to receive aprotinin in high dosage (about 800 mg) during extracorporeal circulation. From the resulting two groups each, one patient was excluded from the study because of postoperative myocardial infarction (control group) and surgical hemorrhage (aprotinin group) leading to a second operation. Although heparin was used for anticoagulation in all 22 patients, all had a marked increase in plasma levels of thrombin-antithrombin III complexes during extracorporeal circulation, indicating an intravasal activation of coagulation. By monitoring the plasma levels of fibrin degradation products in patients without aprotinin therapy, we recorded a concomitant hyperfibrinolysis significantly less pronounced in patients receiving aprotinin (p less than 0.005). The mean total postoperative blood loss was lower in patients receiving aprotinin (620 ml) than in control patients (1000 ml; p less than 0.03). The results confirm previous reports of a hemostyptic effect of aprotinin in cardiac operations. This effect is probably due to a prevention of hyperfibrinolysis.
Havel
M
M
Department of Surgery II, University of Vienna, Austria.
Teufelsbauer
H
H
Knöbl
P
P
Dalmatiner
R
R
Jaksch
P
P
Zwölfer
W
W
Müller
M
M
Vukovich
T
T
D000990:Antithrombin III / Q000032:analysis; D007611:Aprotinin / Q000008:administration & dosage* / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006488:Hemostasis, Surgical; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000032:analysis
D005338:Fibrin Fibrinogen Degradation Products; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D007611:Aprotinin; D010447:Peptide Hydrolases