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[Effect of aprotinin on bleeding during and graft patency after coronary artery bypass grafting]
1Department of Thoracic Surgery, Osaka Medical College, Japan.
Insights
Aprotinin effectively reduces intraoperative bleeding during coronary artery bypass grafting (CABG). However, it significantly decreases early graft patency and increases perioperative myocardial infarction risk.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Anesthesiology
Background:
- Intraoperative bleeding is a significant concern in coronary artery bypass grafting (CABG).
- Aprotinin is a protease inhibitor used to reduce bleeding, but its effect on graft patency requires further investigation.
Purpose of the Study:
- To evaluate the impact of aprotinin on intraoperative bleeding and graft patency in patients undergoing elective CABG.
- To compare the effects of different aprotinin dosages (1,500,000 KIU vs. 300,000 KIU) versus no aprotinin.
Main Methods:
- A randomized controlled trial involving 200 patients undergoing elective CABG.
- Patients were divided into three groups: high-dose aprotinin, low-dose aprotinin, and control (no aprotinin).
- Intraoperative bleeding, reexploration rates, graft patency (via coronary angiography), and perioperative myocardial infarction were assessed.
Main Results:
- High-dose aprotinin significantly reduced intraoperative bleeding and reexploration compared to low-dose and control groups.
- Graft patency was significantly lower in the high-dose aprotinin group (SVG: 90.4%, ITA: 91.1%) compared to the other groups.
- Perioperative myocardial infarction rates were higher in the high-dose aprotinin group (3.7%).
Conclusions:
- Aprotinin effectively reduces intraoperative bleeding in CABG patients.
- However, aprotinin use is associated with decreased early graft patency and increased risk of perioperative myocardial infarction.
- Routine use of aprotinin in CABG is not recommended unless patients have a bleeding tendency, such as in emergency or redo surgeries.
Abstract:
The purpose of this study was to evaluate the effect of aprotinin on intraoperative bleeding and graft patency in 200 patients undergoing elective CABG. Patients were classified into three groups; patients receiving 1500000 KIU of aprotinin (group A), 300000 KIU of aprotinin (group B) and no aprotinin as the control (group C). The groups were almost the same as to age, sex, number of grafts and use of ITA. Intraoperative bleeding and reexploration were significantly decreased in group A compared with group B and C. All patients underwent coronary angiography between the 4th and 8th post-operative weeks. Graft patency was significantly decreased in group A (SVG: 90.4%, ITA: 91.1%) compared with group B (SVG: 95.3%, ITA: 100%) and C (SVG: 95.5%, ITA: 99.2%). Perioperative myocardial infarction increased in group A (3.7%). Aprotinin was effective in reducing intraoperative bleeding in CABG, but decreased early graft patency after CABG. It is suggested that aprotinin should not be used routinely in CABG unless a patient has bleeding tendency which is likely to be seen in emergency and redo surgery.