title: Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens.
abstract: BACKGROUND
  High-dose aprotinin reduces transfusion requirements in patients undergoing coronary artery bypass grafting, but the safety and effectiveness of smaller doses is unclear. Furthermore, patient selection criteria for optimal use of the drug are not well defined.
  
  
  METHODS
  Seven hundred and four first-time coronary artery bypass grafting patients were randomized to receive one of three doses of aprotinin (high, low, and pump-prime-only) or placebo. The patients were stratified as to risk of excessive bleeding.
  
  
  RESULTS
  All three aprotinin doses were highly effective in reducing bleeding and transfusion requirements. Consistent efficacy was not, however, demonstrated in the subgroup of patients at low risk for bleeding. There were no differences in mortality or the incidences of renal failure, strokes, or definite myocardial infarctions between the groups, although the pump-prime-only dose was associated with a small increase in definite, probable, or possible myocardial infarctions (p = 0.045).
  
  
  CONCLUSIONS
  Low-dose and pump-prime-only aprotinin regimens provide reductions in bleeding and transfusion requirements that are similar to those of high-dose regimens. Although safe, aprotinin is not routinely indicated for the first-time coronary artery bypass grafting patient who is at low risk for postoperative bleeding. The pump-prime-only dose is not currently recommended because of a possible association with more frequent myocardial infarctions.
authors.affiliation: Good Samaritan Hospital, Portland, Oregon.
authors.forename: J H
authors.initials: JH
authors.lastname: Lemmer
authors.forename: E W
authors.initials: EW
authors.lastname: Dilling
authors.forename: J R
authors.initials: JR
authors.lastname: Morton
authors.forename: J B
authors.initials: JB
authors.lastname: Rich
authors.forename: F
authors.initials: F
authors.lastname: Robicsek
authors.forename: D L
authors.initials: DL
authors.lastname: Bricker
authors.forename: C B
authors.initials: CB
authors.lastname: Hantler
authors.forename: J G
authors.initials: JG
authors.lastname: Copeland
authors.forename: J L
authors.initials: JL
authors.lastname: Ochsner
authors.forename: P O
authors.initials: PO
authors.lastname: Daily
authors.forename: C W
authors.initials: CW
authors.lastname: Whitten
authors.forename: G P
authors.initials: GP
authors.lastname: Noon
authors.forename: R
authors.initials: R
authors.lastname: Maddi
mesh_terms: D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage* / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012307:Risk Factors
chemical_list: D006490:Hemostatics; D007611:Aprotinin