Plasma aprotinin concentrations during cardiac surgery: full- versus half-dose regimens.
Aprotinin is an effective but expensive drug used during cardiac surgery to reduce blood loss and transfusion requirements. Currently, aprotinin is administered to adults according to a fixed protocol regardless of the patient's weight. The purpose of this study was to determine aprotinin levels in patients receiving full- and half-dose aprotinin regimens by a simple functional aprotinin assay and to design a more individualized aprotinin dosage regimen for cardiac surgical patients. The mean plasma aprotinin concentration peaked 5 min after the initiation of cardiopulmonary bypass (full 401 +/- 92 KIU/mL, half 226 +/- 56 KIU/mL). The mean plasma aprotinin concentration after 60 min on cardiopulmonary bypass was less (full 236 +/- 81 KIU/mL, half 160 +/- 63 KIU/mL). There was large variation in the aprotinin concentration among patients. A statistically significant correlation was found between aprotinin concentration and patient weight (r(2) = 0.67, P < 0.05).


CONCLUSIONS
The current dosing schedule for aprotinin results in a large variation in aprotinin plasma concentrations among patients and a large variation within each patient over time. We combined the information provided by our study with that of a previous pharmacokinetic study to develop a potentially improved, weight-based, dosing regime for aprotinin.
Beath
S M
SM
Departments of Cardiovascular Anesthesiology and Anesthesiology, Mayo Graduate School of Medicine, Rochester, MN 55905, USA.
Nuttall
G A
GA
Fass
D N
DN
Oliver
W C
WC
Ereth
M H
MH
Oyen
L J
LJ
D007611:Aprotinin / Q000008:administration & dosage* / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D001835:Body Weight; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged
D006490:Hemostatics; D007611:Aprotinin