title: Review of efficacy parameters.
abstract: BACKGROUND
  The deleterious effects of cardiopulmonary bypass are greater in pediatric patients than in adults. The use of aprotinin to manipulate hemostasis has become an important factor in attempts to reduce adverse consequences of these effects.
  
  
  METHODS
  This article reviews the literature on the use of aprotinin in pediatric cardiac surgery.
  
  
  RESULTS
  Available studies have many deficiencies, often including lack of placebo control, nonhomogeneous populations and procedures, and absence of information on aprotinin plasma concentrations. Comparison of trial results is further complicated by differences in dose regimens, heparin-protamine protocols, and priming.
  
  
  CONCLUSIONS
  Further trials are required to adequately assess aprotinin effect on platelet preservation, particularly in neonates, to evaluate aprotinin's antiinflammatory action, and to determine optimum dosages to achieve specific objectives. Aprotinin in pediatric cardiac surgery has been found to be associated with no adverse effects, to decrease fibrinolytic and probably platelet activation, and to offer important clinical benefits in specific groups of patients.
authors.affiliation: Hôpital Laënnec, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Pouard
mesh_terms: D007611:Aprotinin / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D010372:Pediatrics; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D015842:Serine Proteinase Inhibitors; D007611:Aprotinin