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Does use of aprotinin in coronary artery bypass graft surgery affect graft patency?
Maninder Kalkat1, Adrian Levine, Joel Dunning
1Department of Cardiothoracic Surgery, North Staffordshire Royal Infirmary, Stoke, UK.
Insights
Aprotinin (a proteinase inhibitor) reduces bleeding during coronary artery bypass graft surgery but may increase the risk of saphenous vein graft occlusion, impacting long-term graft patency.
Area of Science:
- Cardiac Surgery
- Pharmacology
- Vascular Biology
Background:
- Aprotinin is used in cardiac surgery to reduce blood loss and transfusion requirements.
- The impact of aprotinin on coronary artery bypass graft (CABG) patency remains a clinical concern.
Purpose of the Study:
- To evaluate the effect of aprotinin use on saphenous vein graft patency in patients undergoing coronary artery bypass graft surgery.
Main Methods:
- A systematic review of 45 identified papers was conducted.
- Ten papers presenting the best evidence were selected for analysis.
- Data on patient groups, study types, outcomes, and results were tabulated.
Main Results:
- Aprotinin significantly reduces blood loss, the need for blood transfusions, and reoperation for bleeding.
- Evidence suggests aprotinin use increases the risk of saphenous vein graft occlusion.
Conclusions:
- While beneficial for reducing perioperative bleeding, aprotinin may negatively affect long-term saphenous vein graft patency.
- The increased risk of graft occlusion warrants careful consideration in clinical decision-making.
Abstract:
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether use of aprotinin in coronary artery bypass graft surgery adversely affects graft patency. Altogether 45 papers were identified using the below mentioned search, of which 10 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that aprotinin clearly reduces blood loss, requirement for blood transfusion, and the risk of reoperation for bleeding, but does increase the risk of saphenous vein graft occlusion.
