title: Effect of reduced aprotinin dosage on blood loss and use of blood products in patients undergoing cardiopulmonary bypass.
abstract: High-dose aprotinin reduces bleeding after cardiac surgery, but has also evoked concern with regard to potential side effects and hospital costs. To evaluate the effects of reduced-dose aprotinin on blood loss and need for blood transfusion, 40 patients undergoing myocardial revascularization were studied (double-blind, placebo-controlled). Postoperative bleeding was reduced by 40% and erythrocyte infusion by 85% in the group given 3 x 10(6) KIU aprotinin (1 x 10(6) as a loading dose before cardiopulmonary bypass, 1 x 10(6) in the priming volume and 2.5 x 10(5)/hour intraoperatively) Aprotinin concentrations during the operation were monitored and maintained above the required level. There were no adverse effects of the drug. Hospital expenditure on blood products was reduced by 51% when aprotinin was used. Our study suggests that aprotinin in reduced dosage diminishes bleeding and requirements for blood products, and that it should be given before, during and after cardiopulmonary bypass.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sahlgrenska Hospital, University of Gothenburg, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Liu
authors.forename: A
authors.initials: A
authors.lastname: Belboul
authors.forename: G
authors.initials: G
authors.lastname: Rådberg
authors.forename: L
authors.initials: L
authors.lastname: Tengborn
authors.forename: L
authors.initials: L
authors.lastname: Dernevik
authors.forename: D
authors.initials: D
authors.lastname: Roberts
authors.forename: G
authors.initials: G
authors.lastname: William-Olsson
mesh_terms: D000368:Aged; D007611:Aprotinin / Q000097:blood / Q000191:economics / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003365:Costs and Cost Analysis; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion; D005260:Female; D006488:Hemostasis, Surgical / Q000191:economics / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D007611:Aprotinin