title: Mini-dose pump-prime aprotinin inhibited enhanced fibrinolytic activity and reduced blood loss and transfusion requirements after coronary artery bypass surgery.
abstract: OBJECTIVE
  Low-dose aprotinin in the pump during cardiopulmonary bypass (CPB) has been shown to improve postoperative hemostasis and platelet preservation. This investigation was undertaken to evaluate the effects of mini-dose pump prime only aprotinin (70 mg) on the hemostatic parameters and blood transfusion requirements in patients undergoing on-pump coronary artery bypass surgery (CABG).
  
  
  METHODS
  We studied 86 patients who underwent CABG. Forty patients received mini-dose aprotinin (500.000 KIU [70 mg] in the pump), and a control group of 46 did not. D-dimer level, full blood count, postoperative blood loss, and transfusion requirements were analyzed before, after one hour operation and first day after operation.
  
  
  RESULTS
  Twenty-four-hour postoperative blood loss was significantly reduced in the aprotinin group (188+/- 51.5 ml vs. 818+/- 243.5 ml, [mean +/- standard deviation] p < 0.01). Patients in the aprotinin group also received significantly less banked blood posoperatively than the control group (1.20 +/- 0.52 vs. 3.33 +/- 1.13 Units/per patient (p < 0.04). One hour after operation, and 24 hours after operation D-dimer level was significantly reduced in the aprotinin group (p < 0.008 and p < 0.017, respectively).
  
  
  CONCLUSIONS
  Mini dose pump-prime aprotinin reduces postoperative blood loss, transfusion requirements and yet confers hemostatic improvement through reduced fibrinolysis in patients undergoing routine coronary artery bypass grafting.
authors.affiliation: Department of Cardiovascular Surgery, Research Hospital, Harran University, Sanliurfa, TR-63100, Turkey. dralper@msn.com
authors.forename: Alper Sami
authors.initials: AS
authors.lastname: Kunt
authors.forename: Osman Tansel
authors.initials: OT
authors.lastname: Darcin
authors.forename: Salih
authors.initials: S
authors.lastname: Aydin
authors.forename: Deniz
authors.initials: D
authors.lastname: Demir
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Selli
authors.forename: Mehmet Halit
authors.initials: MH
authors.lastname: Andac
mesh_terms: D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D007611:Aprotinin