Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens
| Autor: | Donald L. Bricker, Charles B. Hantler, John L. Ochsner, Pat O. Daily, Jack G. Copeland, Emery W. Dilling, Charles W. Whitten, Rosemarie Maddi, Jeffrey B. Rich, Francis Robicsek, George P. Noon, Jeremy R. Morton, John H. Lemmer |
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| Rok vydání: | 1996 |
| Předmět: |
Pulmonary and Respiratory Medicine
Excessive Bleeding Male medicine.medical_specialty Blood transfusion medicine.medical_treatment Blood Loss Surgical Myocardial Infarction Hemostatics law.invention Aprotinin Randomized controlled trial Double-Blind Method law Risk Factors Multicenter trial Cardiopulmonary bypass medicine Humans Blood Transfusion Derivation Coronary Artery Bypass Intraoperative Complications Aged business.industry Middle Aged Surgery Anesthesia Female Cardiology and Cardiovascular Medicine business Complication medicine.drug |
| Zdroj: | The Annals of thoracic surgery. 62(6) |
| ISSN: | 0003-4975 |
| Popis: | Background . High-dose aprotinin reduces transfusion requirements in patients undergoing coronary artery bypass grafting, but the safety and effectiveness of smaller doses is unclear. Furthermore, patient selection criteria for optimal use of the drug are not well defined. Methods . Seven hundred and four first-time coronary artery bypass grafting patients were randomized to receive one of three doses of aprotinin (high, low, and pump-prime-only) or placebo. The patients were stratified as to risk of excessive bleeding. Results . All three aprotinin doses were highly effective in reducing bleeding and transfusion requirements. Consistent efficacy was not, however, demonstrated in the subgroup of patients at low risk for bleeding. There were no differences in mortality or the incidences of renal failure, strokes, or definite myocardial infarctions between the groups, although the pump-prime-only dose was associated with a small increase in definite, probable, or possible myocardial infarctions ( p = 0.045). Conclusions . Low-dose and pump-prime-only aprotinin regimens provide reductions in bleeding and transfusion requirements that are similar to those of high-dose regimens. Although safe, aprotinin is not routinely indicated for the first-time coronary artery bypass grafting patient who is at low risk for postoperative bleeding. The pump-prime-only dose is not currently recommended because of a possible association with more frequent myocardial infarctions. |
| Databáze: | OpenAIRE |
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