Is aprotinin safe to use in a cohort at increased risk for thrombotic events: results from a randomized, prospective trial in off-pump coronary artery bypass.

The Annals of Thoracic Surgery
Michael C GrantRobert S Poston

Abstract

Multiple randomized trials have established a favorable safety profile for aprotinin use during cardiac surgery, but recent database analyses suggest an increased risk of adverse thrombotic events. Our group previously demonstrated that off-pump coronary artery bypass (OPCAB) is linked to a postoperative hypercoagulable state. In this study, we tested whether aprotinin influences thrombotic events after OPCAB. Patients randomly received saline (n = 61) or aprotinin (2 x 10(6) kallikrein inhibiting units (KIU) loading dose, 0.5 x 10(6) KIU/hour [n = 59]) during OPCAB. Aprotinin levels (KIU/mL) were analyzed before, and 30 minutes (peak) and 4 hours after the loading dose. Estimated glomerular filtration rate (eGFR) was calculated daily based on Cockcroft equation with acute kidney injury (AKI) defined as eGFR less than 75% of baseline. Major adverse cardiac and cerebrovascular events (MACCE) were monitored during the first year, including acute graft failure by predischarge computed tomographic angiography. Compared with placebo, the aprotinin group developed a significantly lower eGFR on day 3 (p < 0.006), but this difference resolved by day 5. Peak aprotinin level correlated with the degree of eGFR decline noted on day 3 (r = ...Continue Reading

References

Dec 1, 1991·Journal of Cardiothoracic and Vascular Anesthesia·D Royston
Jan 29, 2002·Anesthesia and Analgesia·Gregory A NuttallMark H Ereth
Sep 17, 2002·Arteriosclerosis, Thrombosis, and Vascular Biology·Dougald M MonroeHarold R Roberts
Sep 21, 2002·BMJ : British Medical Journal·Dean FergussonPaul Hébert
Aug 18, 2004·Critical Care : the Official Journal of the Critical Care Forum·Rinaldo BellomoUNKNOWN Acute Dialysis Quality Initiative workgroup
Sep 9, 2004·The Journal of Thoracic and Cardiovascular Surgery·Artyom SedrakyanJohn A Elefteriades
Aug 4, 2005·ANZ Journal of Surgery·Mitsugu OgawaAtsushi Fukumoto
Jan 27, 2006·The New England Journal of Medicine·Dennis T ManganoUNKNOWN Ischemia Research and Education Foundation
May 16, 2006·Critical Care : the Official Journal of the Critical Care Forum·Eric A J HosteJohn A Kellum
Sep 9, 2006·Seminars in Cardiothoracic and Vascular Anesthesia·J R S DayK M Taylor
Nov 8, 2006·Circulation·Rajendra H MehtaUNKNOWN Society of Thoracic Surgeons National Cardiac Surgery Database Investigators
Jan 3, 2007·The Journal of Thoracic and Cardiovascular Surgery·Hisato TakagiTakuya Umemoto
Feb 8, 2007·JAMA : the Journal of the American Medical Association·Dennis T ManganoUNKNOWN Ischemia Research and Education Foundation
May 22, 2007·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·R K WaliM R Weir
Jan 1, 2006·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Zachary N KonRobert S Poston

❮ Previous
Next ❯

Citations

May 11, 2013·British Journal of Anaesthesia·E OrtmannA A Klein
Dec 1, 2012·Anaesthesia and Intensive Care·E M MooreA D Nichol

❮ Previous
Next ❯

Related Concepts

Related Feeds

Blood Coagulation Signaling Pathways

Coagulation is the process by which a blood clot is formed. This process includes both the formation of a platelet plug as well as a cascade of clotting factors resulting in the formation of fibrin strands. Find the latest research on coagulation signaling pathways here.

Blood Clotting Disorders

Thrombophilia includes conditions with increased tendency for excessive blood clotting. Blood clotting occurs when the body has insufficient amounts of specialized proteins that make blood clot and stop bleeding. Here is the latest research on blood clotting disorders.