Aprotinin dosing: how much is enough?

Coagulopathy and postoperative bleeding continue to be a major concern for patients undergoing cardiac surgery with cardiopulmonary bypass. Pharmacologic attenuation of this morbidity has been one area that clinicians have held in high interest. Aprotinin, a serine protease inhibitor, has been shown to be effective in reducing bleeding as well as the need for blood component transfusions. Although effective, aprotinin is an expensive drug and this, in conjunction with a cost-conscious community, has led clinicians to determine what is the lowest effective dose of aprotinin. From these studies, various aprotinin dosing regimens have been studied with differing results. The purpose of this work is to review the effectiveness of the various dosing strategies and to examine potential benefits of a dosing regimen based on a patient's weight, which may allow clinicians to achieve the maximal benefits from aprotinin without overdosing patients.