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Aprotinin for coronary artery bypass grafting: effect on postoperative renal function
J H Lemmer1, W Stanford, S L Bonney
1Department of Surgery, University of Iowa College of Medicine, Iowa City.
The Annals of Thoracic Surgery
|January 1, 1995
Summary
High-dose aprotinin did not significantly increase the risk of serious kidney problems in patients undergoing coronary artery bypass graft surgery. Renal insufficiency was infrequent and similar between the aprotinin and placebo groups.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Coronary artery bypass graft (CABG) surgery is a major cardiovascular procedure.
- Aprotinin is a serine protease inhibitor used to reduce bleeding during cardiac surgery.
- Concerns exist regarding potential renal toxicity of aprotinin.
Purpose of the Study:
- To evaluate the incidence of postoperative renal insufficiency in patients undergoing CABG who received high-dose aprotinin compared to placebo.
- To assess the safety profile of aprotinin concerning renal function.
Main Methods:
- A randomized, placebo-controlled trial involving 216 patients undergoing CABG.
- Patients were randomized to receive either high-dose aprotinin or a placebo.
- Renal function was monitored through serum creatinine, blood urea nitrogen, electrolyte levels, urinalysis, and creatinine clearance rates.
Main Results:
- Clinically important renal insufficiency requiring dialysis was rare and occurred in one patient (0.9%) in each group.
- Postoperative increases in serum creatinine were observed more frequently in the aprotinin group (20/108) than the placebo group (13/108), but this difference was not statistically significant (p = 0.186).
- Increases in serum creatinine were generally small and transient, with no significant differences between groups in other renal function parameters.
Conclusions:
- Aprotinin use at high doses during CABG surgery does not appear to be associated with a significant risk of serious renal toxicity.
- The observed renal function changes were minimal and transient, suggesting a favorable renal safety profile under the studied conditions.