Mini-dose pump-prime aprotinin inhibited enhanced fibrinolytic activity and reduced blood loss and transfusion requirements after coronary artery bypass surgery.
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.
Kunt
Alper Sami
AS
Department of Cardiovascular Surgery, Research Hospital, Harran University, Sanliurfa, TR-63100, Turkey. dralper@msn.com
Darcin
Osman Tansel
OT
Aydin
Salih
S
Demir
Deniz
D
Selli
Cuneyt
C
Andac
Mehmet Halit
MH
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
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D007611:Aprotinin