The use of micro-dose aprotinin with continuous infusion in coronary artery bypass surgery.
BACKGROUND
To evaluate the efficacy of aprotinin at a dose far less than standard.


METHODS



METHODS
Retrospective, case-control study.


METHODS
community-based, teaching hospital


METHODS
one hundred one patients undergoing primary, non-emergent, coronary artery bypass during two, six-month periods were studied.


METHODS
during the first period aprotinin was not administered, and these patients served as controls (n = 52). During the second period all patients received aprotinin via a micro-dose regimen (n = 49).


METHODS
postoperative bleeding and blood product usage served as determinants of efficacy.


RESULTS
A significant difference existed in postoperative bleeding with the mean thoracic drain outputs being reduced in the aprotinin group both at 6 hours (p = 0.0003) and in total (p = 0.0004). This was further supported by significantly higher hematocrits (p = 0.03) on the first postoperative day in patients receiving aprotinin. Likewise, there was a significant reduction in total blood product exposures (p = 0.04) and platelet usage (p = 0.02) in the aprotinin group with a tendency towards decreased red cell usage. Further, when all patients with a hematocrit < or =30% prior to bypass were excluded, the significant reduction in total blood product exposures persisted (p = 0.04), and there was a significant reduction in red cell usage (p = 0.04) with a trend towards decreased platelet usage (p = 0.06) in the aprotinin group.


CONCLUSIONS
Micro-dose aprotinin significantly reduces postoperative bleeding and blood product usage in primary, non-emergent, CABG patients.
Holmes
J H
JH
Department of General Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Jones
M F
MF
Anderson
R P
RP
Knopes
K D
KD
Guyton
S W
SW
Hall
R A
RA
D007611:Aprotinin / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D017707:Erythrocyte Transfusion; D005260:Female; D006400:Hematocrit; D006801:Humans; D007262:Infusions, Intravenous; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control*; D012189:Retrospective Studies; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage*; D016896:Treatment Outcome
D015842:Serine Proteinase Inhibitors; D007611:Aprotinin