s S OTHING QUITE RAISES the ire or brings out the torches and the pitchforks in the cardiothoracic anesthesia circles ore than a discussion about aprotinin. Much has been disussed and published regarding the broad-acting serine proease inhibitor. Keen interest in aprotinin began with Royston et l’s1 published report showing that the use of the drug resulted n an 8-fold decrease in the need for ...

BACKGROUND To compare the effect of aprotinin with the effect of lysine analogues (tranexamic acid and ε-aminocaproic acid) on early mortality in three subgroups of patients: low, intermediate and high risk of cardiac surgery. METHODS AND FINDINGS We performed a meta-analysis of randomised controlled trials and observational with the following data sources: Medline, Cochrane Library, and refe...

The activated clotting time (ACT) is used frequently for monitoring blood anticoagulant response with heparin before, during, and after cardiopulmonary bypass (CPB). Many cardiac procedures involving CPB require reduction of the patient's blood temperature and use of the serine protease inhibitor, aprotinin. Three different methods of ACT measurement were compared to show the effects of differe...

BACKGROUND Graft reperfusion in orthotopic liver transplantation is often associated with significant hemodynamic changes, including decreased systemic vascular resistance and arterial blood pressure. Vasopressive drugs are often required to maintain adequate perfusion pressure during the early postreperfusion period. The exact mechanism of this postreperfusion syndrome is unknown, but release ...

OBJECTIVE Hypersensitivity to aprotinin is low (1-3%) but more likely with re-exposure. The manufacturer issued a black box warning which lists aprotinin re-exposure within 1 year of prior exposure as a contraindication. We investigated the temporal relationship between re-exposure interval and hypersensitivity in children. METHODS With Human Research Review Board approval, charts of all pati...

We have investigated the role of an aprotinin-sensitive protease in regulating Ca(2+)-ATPase activity and Ca2+ uptake (ATP-dependent and Na(+)-dependent) in microsomes of bovine pulmonary vascular smooth muscle during treatment with the O2(-.)-generating system hypoxanthine plus xanthine oxidase. Treatment of the smooth muscle microsomes with the O2(-.)-generating system produced a protease in ...

BACKGROUND Neonates undergoing open-heart surgery are particularly at risk of postoperative bleeding requiring blood transfusion. Aprotinin has attained high efficacy in reducing the requirement for a blood transfusion following a cardiopulmonary bypass, but is seldom studied in the neonatal age group. The aim of this study was to compare the efficacy and adverse effects of aprotinin and tranex...

The use of aprotinin in cardiac surgery to reduce perioperative bleeding and transfusion is controversial. We assessed the effect of aprotinin on the risk of acute renal failure in 423 patients who underwent on-pump cardiac surgery between January 1, 2005 and December 31, 2006. Of these 423 patients, 318 (75.2%) received aprotinin (median dose=3.0 million KIU, standard deviation=2.8 million KIU...

OBJECTIVE To determine whether two low dose aprotinin regimens produce clinically significant reductions in postoperative blood loss compared with a control group. DESIGN A randomised double blind placebo controlled study. SETTING A regional cardiothoracic unit in London. PATIENTS 79 patients were consecutively allocated to one of three groups. All patients had primary elective surgery wi...

BACKGROUND Concerns regarding the safety of transfused blood have led to the development of a range of interventions to minimise blood loss during major surgery. Anti-fibrinolytic drugs are widely used, particularly in cardiac surgery and previous reviews have found them to be effective in reducing blood loss and the need for transfusion. Recently, questions have been raised regarding the compa...