title: Topical aprotinin in cardiac operations.
abstract: We performed a prospective, randomized, double-blind trial of topical aprotinin versus placebo in 100 patients undergoing cardiac operations with cardiopulmonary bypass. Fifty-five patients received aprotinin. Forty underwent coronary artery bypass grafting (CABG) and 15 valve replacement +/- CABG. Of 45 patients in the control group 38 underwent CABG and 7 valve replacement +/- CABG. Aprotinin (50 mL; 70 mg) or placebo was applied topically to the heart, pericardium, and mediastinum before sternal closure. There were five reentries for bleeding with a surgical site identified in four. Mean blood loss was significantly less in the aprotinin group (653 versus 903 mL; p = 0.002), and fewer aprotinin patients received blood as a volume expander (67.5% versus 88%; p = 0.03). In coronary patients alone when aspirin administration was continued until the day of operation there was no difference between treatment and placebo groups (768 versus 879 mL). When aspirin administration was discontinued 2 weeks before operation there was a significant difference (558 versus 884 mL; p = 0.016) as in the group overall. This provides the potential for intrapericardial instillation for patients with excessive postoperative bleeding.
authors.affiliation: Oxford Heart Centre, John Radcliffe Hospital, England.
authors.forename: D J
authors.initials: DJ
authors.lastname: O'Regan
authors.forename: N
authors.initials: N
authors.lastname: Giannopoulos
authors.forename: N
authors.initials: N
authors.lastname: Mediratta
authors.forename: S W
authors.initials: SW
authors.lastname: Kendall
authors.forename: A
authors.initials: A
authors.lastname: Forni
authors.forename: R
authors.initials: R
authors.lastname: Pillai
authors.forename: S
authors.initials: S
authors.lastname: Westaby
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001021:Aortic Valve; D007611:Aprotinin / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011292:Premedication; D011446:Prospective Studies; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D014859:Warfarin; D007611:Aprotinin; D001241:Aspirin