title: The use of micro-dose aprotinin with continuous infusion in coronary artery bypass surgery.
abstract: 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.
authors.affiliation: Department of General Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Holmes
authors.forename: M F
authors.initials: MF
authors.lastname: Jones
authors.forename: R P
authors.initials: RP
authors.lastname: Anderson
authors.forename: K D
authors.initials: KD
authors.lastname: Knopes
authors.forename: S W
authors.initials: SW
authors.lastname: Guyton
authors.forename: R A
authors.initials: RA
authors.lastname: Hall
mesh_terms: 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
chemical_list: D015842:Serine Proteinase Inhibitors; D007611:Aprotinin