Maintenance of therapeutic plasma aprotinin levels during prolonged cardiopulmonary bypass using a large-dose regimen.
Aprotinin concentrations in the range of 127-191 kallikrein inactivator units (KIU)/mL at the end of cardiopulmonary bypass (CPB) (< 2 h duration) reduce transfusion requirements. It has been suggested that prolonged CPB may require higher infusion rates which significantly increase cost. We tested the hypothesis that large-dose aprotinin maintains therapeutic plasma levels during prolonged periods of CPB (< 2 h). Aprotinin was administered as follows: 2 x 10(6) KIU upon skin incision; 0.5 x 10(6) KIU/h x 4-h infusion on initiation of CPB; and 2 x 10(6) KIU added to the CPB prime solution. Aprotinin activity was measured 1) 30 min after initiation of drug administration (Pre-CPB); 2) 30 min after initiation of CPB (CPB + 30); 3) 90 min after initiation of CPB (CPB + 90); and 4) at CPB termination (End CPB). CPB duration (mean +/- SD) was 158 +/- 51 min. Plasma aprotinin concentrations (KIU/mL, mean +/- SD) were: 234 +/- 30 at Pre-CPB; 229 +/- 35 at CPB + 30; 184 +/- 27 at CPB + 90; and 179 +/- 22 at End CPB. In all patients, aprotinin levels at the completion of CPB were in the range previously reported to be effective. The authors conclude that large-dose regimen limited to 6 x 10(6) KIU maintained therapeutic plasma aprotinin concentrations during prolonged CPB.
Bennett-Guerrero
E
E
Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029, USA.
Sorohan
J G
JG
Howell
S T
ST
Ayuso
L
L
Cardigan
R A
RA
Newman
M F
MF
Mackie
I J
IJ
Reves
J G
JG
Mythen
M G
MG
D007611:Aprotinin / Q000008:administration & dosage / Q000097:blood* / Q000191:economics / Q000627:therapeutic use; D001803:Blood Transfusion; D002314:Cardioplegic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000379:methods; D001026:Coronary Artery Bypass; D003365:Costs and Cost Analysis; D062109:Dermatologic Surgical Procedures; D004334:Drug Administration Schedule; D005260:Female; D006324:Heart Arrest, Induced; D006351:Heart Valves / Q000601:surgery; D006440:Hemofiltration; D006490:Hemostatics / Q000008:administration & dosage / Q000097:blood* / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D013997:Time Factors
D002314:Cardioplegic Solutions; D006490:Hemostatics; D007611:Aprotinin