title: Aprotinin reduces bleeding and blood product use in patients treated with clopidogrel before coronary artery bypass grafting.
abstract: BACKGROUND
  An increased proportion of patients undergoing urgent coronary artery bypass graft surgery (CABG) is being treated with clopidogrel, an irreversible platelet inhibitor. Clopidogrel in combination with aspirin is known to augment bleeding, transfusion requirements, and reoperation rates after CABG. Aprotinin, a protease inhibitor, is approved for use in cardiac surgery to reduce bleeding. The aim of this study was to investigate whether or not intraoperative use of aprotinin decreases bleeding and number of transfusions after CABG in patients treated with clopidogrel less than 5 days before surgery.
  
  
  METHODS
  We retrospectively reviewed the medical records of all consecutive patients, with preoperative clopidogrel exposure less than 5 days before surgery, who underwent urgent CABG at our institution during 1 year (n = 33). Eighteen patients received a full-dose aprotinin regime intraoperatively whereas 15 patients not receiving aprotinin served as a control group.
  
  
  RESULTS
  The two groups were comparable with respect to baseline characteristics and operative data. Mean postoperative bleeding was 710 mL (95% confidence interval [CI]: 560 to 860) in the aprotinin group versus 1,210 mL (95% CI: 860 to 1550) in the control group (p = 0.004). The aprotinin group received fewer transfusions of packed red blood cells (0.9 U, 95% CI: 0.1 to 1.7, versus 2.7 U, 95% CI: 1.4 to 4.1; p = 0.01), platelets (0.1 U, 95% CI: 0 to 0.3, versus 0.6 U, 0.2 to 0.9; p = 0.02), and fewer blood product units (1.1 U, 95% CI: 0.1 to 2.0, versus 3.7 U, 95% CI: 2.1 to 5.4; p = 0.002). There were 3 reoperations for bleeding, all in the control group (p = 0.05).
  
  
  CONCLUSIONS
  Aprotinin reduces bleeding, transfusion requirements of packed red blood cells, platelets, and total blood units in patients on clopidogrel undergoing urgent CABG.
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Lindvall
authors.forename: Ulrik
authors.initials: U
authors.lastname: Sartipy
authors.forename: Jan
authors.initials: J
authors.lastname: van der Linden
mesh_terms: D000368:Aged; D007611:Aprotinin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001810:Blood Volume; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D007611:Aprotinin; D000077144:Clopidogrel; D013988:Ticlopidine