Aprotinin: antifibrinolytic and anti-inflammatory mechanisms of action in cardiac surgery with cardiopulmonary bypass.
Cardiopulmonary bypass results in activation of the coagulation, fibrinolytic, inflammatory, and complement cascades. These activated cascades result in a decrease in the number of circulating coagulation factors, hyperfibrinolysis, thrombocytopenia, platelet defects, coagulopathies, and an acute inflammatory response. Patients experiencing cardiac surgery with cardiopulmonary bypass are at risk for many potential problems. The use of aprotinin, an antifibrinolytic agent, has multiple effects that tend to reduce hematological defects and blunts the inflammatory response that is associated with cardiac surgery. The pathophysiological consequences of cellular activation associated with cardiopulmonary bypass, basic mechanisms of action of aprotinin, pharmacodynamic and pharmacokinetic properties, dosing, adverse reactions, and cost/benefit ratio are discussed in this article. Critical care nurses need to know about aprotinin to understand its role in reducing blood loss and transfusions during and after cardiac surgery.
Donahue
Marlene A
MA
Critical Care Nursing Program, Mount Royal College, Calgary, Alberta.
Price
Paula M
PM
D007611:Aprotinin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D003362:Cost-Benefit Analysis; D004347:Drug Interactions; D005342:Fibrinolysis / Q000187:drug effects; D006490:Hemostatics / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D006801:Humans; D018836:Inflammation Mediators / Q000494:pharmacology
D006490:Hemostatics; D018836:Inflammation Mediators; D007611:Aprotinin