Related Experiment Videos
Effect of aprotinin (Trasylol) on aorta-coronary bypass graft patency
B P Bidstrup1, S R Underwood, R N Sapsford
1Humana Hospital Wellington, London, England.
Insights
High-dose aprotinin, a drug that reduces bleeding during heart surgery, did not negatively impact aorta-coronary bypass graft patency in a recent study. This suggests aprotinin can be safely used to minimize blood loss without increasing thrombotic risks.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Hemostasis
Background:
- Aprotinin is known to reduce bleeding in cardiac operations.
- Concerns exist regarding its potential prothrombotic effects, particularly with high doses.
Purpose of the Study:
- To investigate the effect of high-dose aprotinin on the early patency of aorta-coronary bypass grafts.
- To assess whether aprotinin increases the risk of graft occlusion.
Main Methods:
- Prospective, double-blind, placebo-controlled study.
- 90 patients undergoing aorta-coronary bypass surgery.
- Noninvasive assessment of graft patency 7-12 days postoperatively.
Main Results:
- No statistically significant difference in graft patency between the aprotinin and placebo groups (p > 0.05).
- Significantly reduced blood loss and homologous blood use in the aprotinin group.
- 126/131 grafts patent in the aprotinin group vs. 134/138 in the placebo group.
Conclusions:
- High-dose aprotinin does not lead to early saphenous vein graft occlusion after bypass surgery.
- Aprotinin effectively reduces bleeding during cardiopulmonary bypass without inducing a prothrombotic state.
Abstract:
To determine the effect on aorta-coronary bypass grafts of high-dose aprotinin, a drug known to be effective in reducing bleeding after all forms of heart operations, a prospective double-blind study was performed. Graft patency was assessed noninvasively 7 to 12 days (median 9 days) postoperatively in 90 patients. In the aprotinin group, 38 of 43 patients had all grafts patent compared with 43 of 47 in the placebo group. In each group, respectively, 126 of 131 grafts versus 134 of 138 grafts were patent. Neither difference was statistically significant (p > 0.05). Blood loss and homologous blood use were significantly reduced in the aprotinin-treated patients. In this study, high-dose aprotinin did not result in early saphenous vein graft occlusion after aorta-coronary bypass operations. This is further evidence that aprotinin reduces hemostatic derangement during cardiopulmonary bypass without creating a "prothrombotic" situation.