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The impact of aprotinin on coronary artery bypass graft patency
G W Laub1, J B Riebman, C Chen
1Department of Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015-1799.
Insights
Aprotinin significantly reduced bleeding after coronary artery bypass grafting but was associated with a higher rate of graft occlusion. Caution is advised for its routine use due to potential adverse effects on graft patency.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Aprotinin is known to reduce bleeding and transfusion needs in coronary artery bypass grafting (CABG).
- Concerns exist regarding aprotinin's potential negative impact on graft patency due to its hemostatic properties.
Purpose of the Study:
- To evaluate the effect of aprotinin on postoperative bleeding, transfusion requirements, renal function, and graft patency in CABG patients.
- To determine the safety and efficacy of aprotinin in the context of cardiac surgery.
Main Methods:
- A prospective, randomized, double-blind trial involving 47 patients undergoing CABG.
- Patients were divided into two groups: 16 received aprotinin, and 16 received a placebo.
- Graft patency was assessed using ultrafast CT scans 6-8 weeks postoperatively in 32 patients.
Main Results:
- Aprotinin group showed significantly less chest tube drainage (722 mL vs. 1,540 mL; p=0.0006).
- Graft patency analysis revealed occlusion in 31% of patients receiving aprotinin versus 0% in the placebo group (p=0.04).
- No significant differences were observed in transfusion requirements, renal function, myocardial infarction, or other thrombotic complications.
Conclusions:
- High-dose aprotinin effectively reduces hemorrhage following coronary artery bypass grafting.
- Routine use of aprotinin warrants caution due to potential adverse effects on coronary artery graft patency.
Study Design:
Aprotinin has recently been shown to reduce postoperative bleeding and transfusion requirements associated with coronary artery bypass grafting. One concern with its use, however, is that it may have a deleterious effect on graft patency because it promotes hemostasis. Forty-seven patients undergoing coronary artery bypass. Forty-seven patients undergoing coronary artery bypass grafting were enrolled in a prospective, randomized double-blind trial of aprotinin to determine the effect of this agent on postoperative bleeding, transfusion requirements, renal function, and graft patency. The study group was comprised of the 32 patients who underwent technically adequate ultrafast CT scans 6 to 8 weeks postoperatively to determine graft patency. Sixteen patients received aprotinin (aprotinin group) and 16 received placebo (control group).
Results:
Demographic and operative descriptors were comparable between groups. Postoperative mediastinal and chest tube drainage in the aprotinin group was significantly less than that in the control group (722 vs 1,540 mL; p = 0.0006) and the mean blood transfusion requirements were less, but this did not reach significance (125 vs 297 mL; p = 0.42). Analysis of graft patency by patients revealed that 5 patients in the aprotinin group (31%) had at least one occluded graft, while none of the patients in the control group had an occluded graft (p = 0.04). Analysis by graft revealed that 38 of 43 grafts placed in the aprotinin group were patent, while all 38 grafts placed in the placebo group were patent (88.4 vs 100%; p = 0.057). There was no difference in the incidence of myocardial infarction, renal dysfunction or hematologic indexes at discharge between the groups, or evidence of other thrombotic complications.
Conclusion:
We conclude that high-dose aprotinin is effective in reducing hemorrhage after coronary artery bypass grafting. However, its routine use should be approached cautiously due to its possible adverse effects on graft patency.