title: The critical role of aprotinin in controlling haemostasis in conjunction with non-pharmacological blood-saving strategies during routine coronary artery bypass surgery.
abstract: OBJECTIVE
  Aprotinin, a non-specific serine protease inhibitor, has been confirmed to be safe and effective in reducing intra- and postoperative blood drainage, transfusion requirements, and perioperative morbidity and mortality during coronary artery bypass surgery. It is the only one of the currently available haemo-static agents that is approved by the U.S. Food and Drug Administration (FDA) for use in cardiac surgery. However, one major weakness of currently available trials is the lack of information regarding the concomitant usage of aprotinin with blood-saving strategies that have been used more frequently in recent years.
  
  
  METHODS
  Patients undergoing elective first-time coronary artery bypass grafting (n = 172) who were given systemic high-dose aprotinin (n = 85), combined systemic high-dose aprotinin and topical aprotinin (n = 27), or no aprotinin (n = 60) were reviewed retrospectively. The use of all blood-saving procedures was systematically taken in account.
  
  
  RESULTS
  Postoperative blood drainage was significantly less in patients treated with aprotinin than controls (P < 0.0001). Concomitant use of topical aprotinin was accompanied by a postoperative blood loss reduction of 35% compared to systemic aprotinin use alone (P < 0.003). The intra- and postoperative donor blood requirements were dramatically reduced in both aprotinin-treated groups compared to controls, although patients received different blood saving strategies as appropriate (P < 0.0001). A trend of up to 20% lower postoperative blood drainage was noted in patients in whom intraoperative haemodilution and autologuos blood transfusions were used (P > 0.05).
  
  
  CONCLUSIONS
  The present analysis demonstrates that the local and systemic administration of aprotinin is safe and effective in reducing intra- and postoperative blood drainage and transfusion requirements. In elective CABG procedures, aprotinin should still be used even if blood-saving strategies are employed.
authors.affiliation: Department of Surgery, Downtown Medical Centre, Ludwig-Maximilians-University, Nussbaumstr. 20, D-80336 Munich, Germany. philipe.khalil@med.uni-muenchen.de
authors.forename: Philipe N
authors.initials: PN
authors.lastname: Khalil
authors.forename: M
authors.initials: M
authors.lastname: Siebeck
authors.forename: M
authors.initials: M
authors.lastname: Ismail
authors.forename: M N
authors.initials: MN
authors.lastname: Khalil
authors.forename: G
authors.initials: G
authors.lastname: von Knobelsdorff
authors.forename: G
authors.initials: G
authors.lastname: Marx
authors.forename: P
authors.initials: P
authors.lastname: Kalmar
mesh_terms: D000328:Adult; D000368:Aged; D007611:Aprotinin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001026:Coronary Artery Bypass; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*
chemical_list: D015842:Serine Proteinase Inhibitors; D007611:Aprotinin