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Aprotinin
S Robert1, B K Wagner, M Boulanger
1Pfizer-Canada, Pointe-Claire, Québec.
Insights
Aprotinin effectively reduces bleeding during coronary artery bypass graft (CABG) surgery by preserving platelet function and inhibiting fibrinolysis. Further research is needed to fully define its indications, dosing, and safety profile.
Area of Science:
- Pharmacology
- Cardiothoracic Surgery
- Hemostasis
Background:
- Aprotinin is a serine protease inhibitor derived from bovine lung tissue.
- It is utilized in surgical procedures with significant blood loss, particularly coronary artery bypass graft (CABG) surgery.
- Understanding its clinical pharmacology is crucial for optimizing patient outcomes.
Purpose of the Study:
- To review the clinical pharmacology of aprotinin.
- To assess its efficacy and safety in patients undergoing procedures with major blood loss, specifically CABG.
- To synthesize current evidence on aprotinin's mechanisms and applications.
Main Methods:
- Comprehensive MEDLINE search for English and French publications on aprotinin in cardiothoracic surgery and hemorrhage.
- Inclusion of data from Canadian and US product labels.
- Review of abstracts, uncontrolled, and controlled clinical trials, extracting data on design, population, results, and safety.
Main Results:
- Aprotinin demonstrates antifibrinolytic activity and preserves platelet function, thereby decreasing blood loss post-cardiac surgery.
- Clinical trials confirm reduced blood loss and transfusion needs in CABG patients.
- While generally well-tolerated with rare allergic reactions, concerns exist regarding a potential prothrombotic state.
Conclusions:
- Aprotinin is established as an effective hemostatic agent for CABG procedures.
- Further investigation is required to thoroughly define optimal indications, dosing strategies, safety considerations, and the implications of repeated administration.
Objective:
To review the clinical pharmacology of aprotinin in patients undergoing surgical procedures involving major blood loss, namely, coronary artery bypass graft (CABG).
Data Sources:
A MEDLINE search was used to identify French- and English-language publications on aprotinin using the indexing terms aprotinin, cardiothoracic surgery, and hemorrhage. The MEDLINE search was supplemented by review of article bibliographies. Data also were obtained from the approved Canadian and US product labels.
Study Selections:
All abstracts and uncontrolled and controlled clinical trials were reviewed.
Data Extraction:
Study design, population, results, and safety information were retained. Efficacy conclusions were drawn from controlled trials.
Data Synthesis:
Aprotinin, a serine protease inhibitor isolated from bovine lung tissue, decreases bleeding after cardiac surgery by mechanisms including antifibrinolytic activity and preservation of platelet function. Several trials have shown that aprotinin reduced blood loss and transfusion requirements in patients undergoing CABG. Its use in other surgical procedures involving major blood loss has been reported. Aprotinin is well tolerated, with minor allergic reactions being the most frequently reported adverse effect. Although unsubstantiated, the possibility that aprotinin could create a prothrombic state leading to early graft occlusion and formation of microthrombi in renal and coronary vasculatures is of concern.
Conclusions:
Aprotinin is an effective hemostatic agent in CABG. Clear definitions of indications, dosing, safety, and repeated use remain to be investigated thoroughly.