Aprotinin is widely used to prevent bleeding, inhibit systemic inflammatory response and reduce blood transfusions after cardiac surgery. Because it is a bovine protein, aprotinin can induce hypersensitivity reactions. We report a case of fatal anaphylactoid reaction to primary aprotinin exposure in a woman who was admitted for mitral valve replacement. The possibility of anaphylactic reaction ...

Both immunochemical and kinetic evidence suggest that the increase in aprotinin activity in the presence of heparin is not due to an increase in the active form of aprotinin, but rather to a qualitative change in the aprotinin molecule which would lead to an increase in aprotinin activity.

INTRODUCTION New evidence of potential risks of aprotinin in 2006 generated public concern about a previously approved drug that was routinely used. In response, we assembled a team of experts within the institution to form guidelines for the appropriate use of aprotinin in cardiac surgery. We report the basis for the guidelines, their implementation, follow-up and resulting patterns of change ...

BACKGROUND AND OBJECTIVES Various dosages of aprotinin have proven to be effective in reducing blood loss and allogeneic transfusion requirements in cardiopulmonary bypass surgery, despite the controversy surrounding the precise hemostatic mechanisms of this drug. The aim of our prospective, randomized, double-blind study was to assess differences in blood loss and transfusion requirements and ...

BACKGROUND The serine protease inhibitor aprotinin has been successfully used to reduce blood loss in patients undergoing cardiac operations. We studied aprotinin for its ability to modulate leukocyte-endothelial cell interactions after ischemia and reperfusion. METHODS The effects of aprotinin on leukocyte-endothelial cell interactions were observed by intravital microscopy in the rat mesent...

Background—Clopidogrel, an irreversible platelet inhibitor, is used to treat patients with unstable angina. These patients often present for coronary artery bypass graft surgery (CABG) and are at increased risk for perioperative bleeding. The current investigation evaluates the impact of aprotinin on bleeding and transfusion requirements in clopidogrel-treated patients undergoing CABG. Methods ...

Both aprotinin and in vitro heparin and protamine dosing assays (RxDx System) have been shown to reduce postoperative bleeding in the cardiac surgery patient. While celite activated clotting time tests in the presence of heparin are artificially prolonged by aprotinin, the kaolin based ACT is not. In order to optimize heparin anticoagulation management during cardiac surgery when aprotinin is u...

BACKGROUND Because of recent concerns about the safety of aprotinin, we updated our 2007 Cochrane review that compared the relative benefits and risks of aprotinin and the lysine analogues tranexamic acid and epsilon aminocaproic acid. METHODS We searched electronic databases, including CENTRAL, MEDLINE, EMBASE, Google and Google Scholar for trials of antifibrinolytic drugs used in adults sch...

BACKGROUND Surgical coronary revascularization with cardiopulmonary bypass and cardioplegia has been associated with reperfusion injury. The serine protease inhibitor aprotinin has been suggested to reduce reperfusion injury, yet a clinically relevant study examining regional ischemia under conditions of cardiopulmonary bypass and cardioplegia has not been performed. METHODS Pigs were subject...

Bovine aprotinin, a reversible inhibitor of plasmin and kallikrein, has been clinically approved for over two decades to prevent perioperative blood loss during cardiac surgery. However, because of postoperative renal dysfunction in thousands of these patients, aprotinin was voluntarily withdrawn from the market. Our earlier studies indicated that a R24K mutant of the first Kunitz-type domain o...