Low postoperative dose of aprotinin reduces bleeding and is safe in patients receiving clopidogrel before coronary artery bypass surgery. A prospective randomized study.
Clopidogrel (Plavix) given before the operation increases bleeding complications following coronary artery bypass grafting (CABG). High perioperative doses of aprotinin (Trasylol) are known to reduce bleeding and transfusions after cardiac surgery, but may increase the risk of thrombosis, renal impairment, and mortality. The aim of the study was to evaluate the clinical effects of aprotinin given in high doses intra- and postoperatively vs. a low postoperative dose in patients on clopidogrel. Patients admitted for first-time CABG and receiving clopidogrel with or without aspirin, were prospectively randomized either to receive a total of 75,000 kallikrein inhibitor unit (KIU)/kg aprotinin given intra- and postoperatively or 25,000 KIU/kg aprotinin after the operation. Three hundred and ninety-nine patients aged 32-87 years (median 67 years) were included. Postoperative bleeding was slightly different, but moderate in both groups. The transfusion rate was similar, as were the incidences of postoperative neurological disturbances and myocardial infarction. Renal impairment and need for inotropic drugs were more frequent in the high dose group. Thirty-day mortality was similar (high dose 2%, low dose 0.5%, P=0.22). A low postoperative dose of aprotinin in patients receiving clopidogrel is safe and has comparable effects regarding postoperative bleeding complications as a high dose.
Øvrum
Eivind
E
Division of Cardiovascular and Respiratory Medicine and Surgery, Oslo Heart Center, Oslo University Hospital, Rikshospitalet, Norway. eivind.ovrum@hjertesenteret.no
Tangen
Geir
G
Tølløfsrud
Stein
S
Ringdal
Mari-Anne L
MA
Øystese
Rolf
R
Istad
Reidar
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D007611:Aprotinin / Q000008:administration & dosage*; D001803:Blood Transfusion; D002561:Cerebrovascular Disorders / Q000209:etiology; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D004334:Drug Administration Schedule; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007430:Intraoperative Care; D007674:Kidney Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D007611:Aprotinin; D000077144:Clopidogrel; D013988:Ticlopidine