Fibrinolytic activity and bleeding after cardiac surgery with cardiopulmonary bypass and low-dose aprotinin therapy.
Low-dose aprotinin inhibits hyperfibrinolysis in cardiac surgery. However, excessive postoperative bleeding and increased fibrinolysis may occur despite low dose-aprotinin administration. We investigated (i) whether fibrinolytic activity significantly rises under low-dose aprotinin administration, and (ii) whether this is associated with excessive postoperative bleeding (> or = 1000 ml/24 h). In a prospective single-blind trial, 120 consecutive patients were randomized to receive 280 mg aprotinin or no aprotinin before skin incision. D-dimer levels increased significantly to the end of surgery, reaching higher levels in the control group. The risk for excessive bleeding was lower in the aprotinin group (12 versus 37%, = 0.001). Fifteen minutes after heparin reversal, patients were at risk for excessive bleeding, when enhanced fibrinolysis was documented (aprotinin group, D-dimer > or = 1.0 micro g/ml, odds ratio = 9.1, = 0.047; control group, D-dimer > or = 3.0 micro g/ml, odds ratio = 4.6, = 0.014). Ninety-seven per cent of the aprotinin group and 81% of control group patients had no excessive bleeding when the D-dimer plasma level was below these values. We conclude that (i) fibrinolytic activity significantly rises under low-dose aprotinin administration, and (ii) plasma D-dimer levels at end of surgery may help to identify patients who are unlikely to develop excessive postoperative bleeding.
Kuepper
Frank
F
Universitaetsklinik fuer Anaesthesiologie, Intensiv- und Schmerztherapie, Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum, Germany.
Dangas
George
G
Mueller-Chorus
Ansgar
A
Kulka
Peter M
PM
Zenz
Michael
M
Wiebalck
Albrecht
A
D000328:Adult; D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis / Q000187:drug effects / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D016037:Single-Blind Method; D014361:Trypsin Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
D005338:Fibrin Fibrinogen Degradation Products; D014361:Trypsin Inhibitors; C036309:fibrin fragment D; D007611:Aprotinin