Does aprotinin influence the inflammatory response to cardiopulmonary bypass in patients?
OBJECTIVE
Aprotinin has been shown to have anti-inflammatory properties, but its effects on the inflammatory reaction to cardiopulmonary bypass remain controversial. This prospective, randomized, double-blind study evaluated the influence of aprotinin on various blood markers of inflammation during and after cardiopulmonary bypass.


METHODS
Sixty male patients underwent coronary artery bypass grafting. The patients were randomized into 3 groups: a placebo group, a second group receiving 2,000,000 KIU of aprotinin followed by an infusion of 500,000 KIU/h and 2,000,000 KIU in the pump prime, and a third group receiving half this dosage. Measurements of tumor necrosis factor, interleukin 6, interleukin 8, interleukin 10, endotoxin, histamine, complement factors, prekallikrein, and prostaglandin D(2) were obtained at baseline, 30 minutes after study drug loading, 10 minutes after the beginning of cardiopulmonary bypass, before the end of bypass, 4 hours after bypass, and on the first and second postoperative days.


RESULTS
Aprotinin had no significant effect on any of these parameters. As expected, aprotinin reduced early blood loss in both treated groups.


CONCLUSIONS
These results indicate that aprotinin at doses currently used to reduce blood loss has no significant influence on the systemic inflammatory response during moderate hypothermic cardiopulmonary bypass in human subjects, as assessed by the mediators measured in this study.
Schmartz
Denis
D
Department of Anesthesiology, Erasme University Hospital, Brussels, Belgium. denis.schmartz@ulb.ac.be
Tabardel
Yves
Y
Preiser
Jean-Charles
JC
Barvais
Luc
L
d'Hollander
Alain
A
Duchateau
Jean
J
Vincent
Jean-Louis
JL
D007611:Aprotinin / Q000008:administration & dosage / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D004311:Double-Blind Method; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control*
D018836:Inflammation Mediators; D015842:Serine Proteinase Inhibitors; D007611:Aprotinin