Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-19T10:38:23.277Z Has data issue: false hasContentIssue false
  • English
  • Français

Aprotinin; friend or foe? A review of recent medical literature

Published online by Cambridge University Press:  14 November 2006

D. Royston ,
N. van Haaften  and
P. De Vooght
D. Royston
Affiliation:
Royal Brompton and Harefield NHS Trust, Harefield Hospital, Department of Cardiothoracic Anaesthesiaand Critical Care, Harefield, UK
N. van Haaften
Affiliation:
Royal Brompton and Harefield NHS Trust, Harefield Hospital, Department of Cardiothoracic Anaesthesiaand Critical Care, Harefield, UK
P. De Vooght
Affiliation:
Royal Brompton and Harefield NHS Trust, Harefield Hospital, Department of Cardiothoracic Anaesthesiaand Critical Care, Harefield, UK
Get access

Extract

Summary

Recent articles published in peer review journals have questioned the safety of using aprotinin in patients having heart surgery. Also, evidence has been published to suggest an increase in renal events in patients given aprotinin when compared to those where tranexamic acid was used. The present review will focus principally on the first of these articles in relation to previously published data and experience.

Keywords

APROTININCARDIAC SURGICAL PROCEDURESREVIEW, LITERATURETRANEXAMIC ACIDADVERSE EFFECTSBLOOD TRANSFUSION
Type
Review
Information
European Journal of Anaesthesiology , Volume 24 , Issue 1 , January 2007 , pp. 6 - 14
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mangano DT, Tudor IC, Dietzel C. The risk associated with aprotinin in cardiac surgery. New Engl J Med 2006; 354 (4): 353–365.Google Scholar
Hunter D. First, gather the data. New Engl J Med 2006; 354 (4): 329–331.Google Scholar
Vlahakes GJ. The value of phase 4 clinical testing. New Engl J Med 2006; 354 (4): 413–415.Google Scholar
Karkouti K, Beattie WS, Dattilo KM et al. A propensity score case-control comparison of aprotinin and tranexamic acid in high-transfusion-risk cardiac surgery. Transfusion 2006; 46 (3): 327–338.Google Scholar
Royston D, Bidstrup BP, Taylor KM, Sapsford RN. Effect of aprotinin on need for blood transfusion after repeat open-heart surgery. Lancet 1987; 2 (8571): 1289–1291.Google Scholar
Henry DA, Moxey AJ, Carless PA et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2001 2001 (1): CD001886.Google Scholar
Sedrakyan A, Treasure T, Elefteriades JA. Effect of aprotinin on clinical outcomes in coronary artery bypass graft surgery: a systematic review and meta-analysis of randomized clinical trials. J Thorac Cardiovasc Surg 2004; 128 (3): 442–448.Google Scholar
Samama CM, Langeron O, Rosencher N et al. Aprotinin versus placebo in major orthopedic surgery: a randomized, double-blinded, dose-ranging study. Anesth Analg 2002; 95 (2): 287–293, table of contents.Google Scholar
Bedirhan MA, Turna A, Yagan N, Tasci O. Aprotinin reduces postoperative bleeding and the need for blood products in thoracic surgery: results of a randomized double-blind study. Eur J Cardiothorac Surg 2001; 20 (6): 1122–1127.Google Scholar
Lentschener C, Benhamou D, Mercier FJ et al. Aprotinin reduces blood loss in patients undergoing elective liver resection. Anesth Analg 1997; 84 (4): 875–881.Google Scholar
Porte RJ, Slooff MJ. Aprotinin: safe and effective in all patients undergoing orthotopic liver transplantation? Liver Transpl 2001; 7 (9): 808–810.Google Scholar
Cosgrove Dd, Heric B, Lytle BW, et al. Aprotinin therapy for reoperative myocardial revascularization: a placebo-controlled study. Ann Thorac Surg 1992; 54 (6): 1031–1036.Google Scholar
Lemmer Jr JH, Stanford W, Bonney SL et al. Aprotinin for coronary bypass operations: efficacy, safety, and influence on early saphenous vein graft patency. A multicenter, randomized, double-blind, placebo-controlled study. J Thorac Cardiovasc Surg 1994; 107 (2): 543–551.Google Scholar
Levy JH, Pifarre R, Schaff HV et al. A multicenter, double-blind, placebo-controlled trial of aprotinin for reducing blood loss and the requirement for donor-blood transfusion in patients undergoing repeat coronary artery bypass grafting. Circulation 1995; 92 (8): 2236–2244.Google Scholar
Lemmer Jr JH, Dilling EW, Morton JR et al. Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens [see comments]. Ann Thorac Surg 1996; 62 (6): 1659–1667.Google Scholar
Alderman EL, Levy JH, Rich JB et al. Analyses of coronary graft patency after aprotinin use: results from the International Multicenter Aprotinin Graft Patency Experience (IMAGE) trial. J Thorac Cardiovasc Surg 1998; 116 (5): 716–730.Google Scholar
Royston D, Levy JH, Fitch J et al. Full-dose aprotinin use in coronary artery bypass graft surgery: an analysis of perioperative pharmacotherapy and patient outcome. Anesth Analg 2006; 103: 1082–1088.Google Scholar
Smith PK, Muhlbaier LH. Aprotinin: safe and effective only with the full-dose regimen [editorial; comment]. Ann Thorac Surg 1996; 62 (6): 1575–1577.Google Scholar
Lemmer Jr JH, Stanford W, Bonney SL et al. Aprotinin for coronary artery bypass grafting: effect on postoperative renal function. Ann Thorac Surg 1995; 59 (1): 132–136.Google Scholar
Mercieri M, Mercieri A, Tritapepe L et al. High-dose aprotinin with gentamicin–vancomycin antibiotic prophylaxis increases blood concentrations of creatinine and cystatin C in patients undergoing coronary artery bypass grafting. Br J Anaesth 1999; 82 (4): 531–536.Google Scholar
Goldstein DJ, Seldomridge JA, Chen JM et al. Use of aprotinin in LVAD recipients reduces blood loss, blood use, and perioperative mortality. Ann Thorac Surg 1995; 59 (5): 1063–1067.Google Scholar
Bidstrup BP, Harrison J, Royston D, Taylor KM, Treasure T. Aprotinin therapy in cardiac operations: a report on use in 41 cardiac centers in the United Kingdom. Ann Thorac Surg 1993; 55 (4): 971–976.Google Scholar
Blauhut B, Gross C, Necek S, Doran JE, Spath P, Lundsgaard-Hansen P. Effects of high-dose aprotinin on blood loss, platelet function, fibrinolysis, complement, and renal function after cardiopulmonary bypass [see comments]. J Thorac Cardiovasc Surg 1991; 101 (6): 958–967.Google Scholar
Schweizer A, Hohn L, Morel DR, Kalangos A, Licker M. Aprotinin does not impair renal haemodynamics and function after cardiac surgery [see comments]. Br J Anaesth 2000; 84 (1): 16–22.Google Scholar
Mangano DT. Aspirin and mortality from coronary bypass surgery. New Engl J Med 2002; 347 (17): 1309–1317.Google Scholar
Ott E, Moehnle P, Tudor I, Hsu P, Mangano D. CABG-Surgery in Europe and North America: Timelines and Outcomes. Anesthesiology 2003; 99: A254.Google Scholar
Mathew JP, Fontes ML, Tudor IC et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004; 291 (14): 1720–1729.Google Scholar
Nussmeier NA, Mora-Mangano C, Fontes M, Schwann NM, Mangano DT. Hormone replacement therapy is safe in women undergoing coronary artery bypass grafting. Tex Heart Inst J 2005; 32 (4): 507–514.Google Scholar
Drenger B, Gozal Y, Fontes M, Mangano D. The association between ACE inhibitors pattern of use and patient outcome after CABG surgery. Anesthesiology 2006; 105: A1737.Google Scholar
Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 1998; 128 (3): 194–203.Google Scholar
Bucerius J, Gummert JF, Walther T et al. On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal replacement therapy. Ann Thorac Surg 2004; 77 (4): 1250–1256.Google Scholar
Zanardo G, Michielon P, Paccagnella A et al. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg 1994; 107 (6): 1489–1495.Google Scholar
Antunes PE, Prieto D, Ferrao de Oliveira J, Antunes MJ. Renal dysfunction after myocardial revascularization. Eur J Cardiothorac Surg 2004; 25 (4): 597–604.Google Scholar
Kuitunen A, Vento A, Suojaranta-Ylinen R, Pettila V. Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg 2006; 81 (2): 542–546.Google Scholar
Conlon PJ, Stafford-Smith M, White WD et al. Acute renal failure following cardiac surgery. Nephrol Dial Transpl 1999; 14 (5): 1158–1162.Google Scholar
Mora Mangano CT, Neville MJ, Hsu PH, Mignea I, King J, Miller DC. Aprotinin, blood loss, and renal dysfunction in deep hypothermic circulatory arrest. Circulation 2001; 104 (12 Suppl 1): I276–I281.Google Scholar
Brown J, Birkmeyer N, O'Connor J. Aprotinin in cardiac surgery. New Engl J Med 2006; 354 (18): 1953–1957.Google Scholar
Habib RH, Zacharias A, Schwann TA et al. Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome. Crit Care Med 2005; 33 (8): 1749–1756.Google Scholar
Koch CG, Li L, Duncan AI et al. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg 2006; 81 (5): 1650–1657.Google Scholar
Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 2002; 74 (4): 1180–1186.Google Scholar
Kuduvalli M, Oo AY, Newall N et al. Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg 2005; 27 (4): 592–598.Google Scholar
Koch CG, Li L, Duncan AI et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 94 (6): 1608–1616.Google Scholar