[Effect of aprotinin on selected parameters of coagulation and drainage blood loss after cardiac operations in patients without coagulation disorders].
OBJECTIVE
An estimation of influence of different doses of aprotynin on bleeding, coagulation parameters and safety of its use after coronary artery bypass grafting (CABG) in pts without coagulation disorders.


METHODS
91 patients underwent CABG, 73 men, 18 women in age 37 to 76 +/- 56.5 years. Patients were randomly assigned to 3 groups; Group I; 38 pts. 6.5 mln KIU aprotynin. Group II; placebo--30 pts. Group III; 23 pts. 2 mln. KIU. There were 4 measurements 1.--before operation, 2. after discontinuing CPB, 3.--6 h after operation, 4.--24 h after operation. We measured Hb, Ht, PLT Glucose, D-dimers, APTT, TT Fibrynogen, INR, AT3, Ca2+, factor V, VIII, GOT GPT CK, CK-MB, CRP, ACT concentration of Hb in drainage 6 h after operation. There were estimated: renal function profile, drainage loss, perioperative MI, mortality, reoperation rate due to bleeding.


RESULTS
The level of blood count and coagulation parameters did not differ between the groups in any test periods. D-dimer levels were significantly higher in the placebo group than in group I and III. The decrease of fibrin degradation was not related to the dose of aprotynin. Drainage was insignificantly higher in placebo group. Renal function was impaired in neither group. Reoperation rate perioperative infarction and mortality did not differ between the groups, however was highest in group I.


CONCLUSIONS
Aprotynin reduces blood loss after operation in CPB and decrease fibrin degradation independently to the dose of the drug. The high-dose of aprotynin may increase the risk of early graft occlusion in patients without coagulation disorders.
Hirnle
Tomasz
T
Akademia Medyczna we Wrocławiu, Klinika Chirurgii Serca. himlet@wp.pl
Stachurski
Andrzej
A
Goździk
Waldemar
W
Pelczar
Marek
M
Wachnik
Jakub
J
Hirnle
Grzegorz
G
Milczarska
Joanna
J
Kustrzycki
Wojciech
W
D000328:Adult; D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D013504:Cardiovascular Surgical Procedures; D004305:Dose-Response Relationship, Drug; D005260:Female; D005337:Fibrin / Q000378:metabolism; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation
D005338:Fibrin Fibrinogen Degradation Products; D006490:Hemostatics; C036309:fibrin fragment D; D005337:Fibrin; D007611:Aprotinin