title: Topical application of aprotinin in cardiac surgery.
abstract: 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.
authors.affiliation: Heart Institute Ludwigshafen, Cardiac Surgery, Klinikum Ludwigshafen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Isgro
authors.forename: Oliver
authors.initials: O
authors.lastname: Stanisch
authors.forename: Arndt-H
authors.initials: AH
authors.lastname: Kiessling
authors.forename: Semih
authors.initials: S
authors.lastname: Gürler
authors.forename: Peter
authors.initials: P
authors.lastname: Hellstern
authors.forename: Werner
authors.initials: W
authors.lastname: Saggau
mesh_terms: 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
chemical_list: D015415:Biomarkers; D007611:Aprotinin