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Efficacy of minimal dose aprotinin in open heart procedures
M M Maddali1, M Das, R Kausalya
1Department of Cardiac Anaesthesiology, Vijaya Heart Foundation, Vijaya Hospital, Chennai, India.
Insights
A minimal dose of aprotinin significantly reduced blood loss and transfusion needs in cardiac surgery patients. This finding highlights aprotinin
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Anesthesiology
Background:
- Coronary Artery Bypass Graft (CABG) surgery can lead to significant blood loss.
- Minimizing perioperative blood loss and transfusion requirements is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of a minimal dose of aprotinin in reducing postoperative blood loss and transfusion needs during CABG surgery.
- To compare the effectiveness of a standard dose versus a minimal dose of aprotinin against a placebo control.
Main Methods:
- A randomized double-blind study involving 30 patients undergoing CABG surgery.
- Patients were divided into three groups: standard aprotinin dose, minimal aprotinin dose, and placebo control.
- Aprotinin dosages and administration timings were standardized across groups.
Main Results:
- Aprotinin groups showed significantly lower postoperative hemoglobin loss compared to the control group (P<0.01).
- Whole blood transfusion requirements were significantly reduced in both aprotinin groups (p < 0.05 and p<0.01) versus the control.
- Chest closure times were not significantly different between groups.
Conclusions:
- A minimal dose of aprotinin (70 mg) is effective in reducing postoperative blood loss and the need for blood transfusions in CABG patients.
- The minimal dose of aprotinin offers an economical and effective strategy for managing blood loss in cardiac surgery.
- Aprotinin administration, even at a minimal dose, demonstrates significant benefits in reducing transfusion requirements.
Abstract:
In a randomized double blind study, 30 patients posted for CABG surgery were assigned to 3 groups of 10 each. Group A received 140 mg (1,000,000 KIU) of aprotinin after induction of anaesthesia but before sternotomy, an equal amount in the pump prime and a maintenance dose of 70 mg/hr throughout cardiopulmonary bypass (standard dose). Group B received placebo after induction of anaesthesia, 70 mg (500,000 KIU) aprotinin in the pump prime with a placebo as a maintenance dose (minimal dose). Group C received a placebo after induction of anaesthesia, in the prime and as a maintenance dose (control group). The mean chest closure times were insignificantly lower in the aprotinin groups; 35.83 +/- 13.93 mins in group A and 37.5 +/- 10 mins in group B as against 57.25 +/- 26.54 mins in group C. Post-operative haemoglobin loss was significantly lower (P<0.01) in aprotinin groups, 5.42 +/- 1.6 gm in group A and 6.28 +/- 2.49 gms in group B, as against 39.77 +/- 27.51 gm in group C. Whole blood transfusion requirement was also significantly reduced from 4.12 +/- 1.79 units in the control group to 2.5 +/- 0.75 units in group A (p < 0.05) and 2 +/- 1.3 units (p<0.01) in group B. We conclude that a minimal dose of aprotinin 70 mg (500,000 KIU) is effective in reducing postoperative blood loss, blood transfusion requirement and is economical.
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