Topical application of aprotinin in cardiac surgery.
The aim of our study was to compare a systemic and a local aprotinin application in patients during coronary artery bypass graft (CABG) surgery. The advantage of a topical aprotinin application is seen in the fact that this may not lead to systemic side effects. A prospective, randomized study comprising 97 patients was conducted. A dose of 5 x 10(6) KIU aprotinin was given systemically to 49 patients and four doses of 1.25 x 10(6) KIU aprotinin were applied topically to 48 patients by spraying the substance on the target area (A. mammaria interna region and pericardium). We determined markers for the inflammatory response, coagulation system, standard haematological markers and postoperative complications. Exclusion criteria were defined as surgical bleeding, redo operations, neurological, haematological, liver and kidney disorders. Sex, age, perfusion times, mortality, renal failure and strokes were identical in both groups. Biochemical markers and clinical outcome demonstrated no significant differences between the systemic and local applications. Interleukin 6 and elastase were tendentially higher (p = 0.1) in the local group, but with a high standard deviation in each patient. Our results suggest that there is no difference between the perioperative application of 5 x 10(6) KIU systemically given aprotinin and 1.25 x 10(6) KIU locally applied aprotinin.
Isgro
Frank
F
Heart Institute Ludwigshafen, Cardiac Surgery, Klinikum Ludwigshafen, Germany.
Stanisch
Oliver
O
Kiessling
Arndt-H
AH
Gürler
Semih
S
Hellstern
Peter
P
Saggau
Werner
W
D000287:Administration, Topical; D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged
D015415:Biomarkers; D007611:Aprotinin