The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 3 , Pages 487-491 , March 2008

Aprotinin: Twenty-five years of claim and counterclaim

  • Stephen Westaby, PhD, FECTS, FACC

      Affiliations

    • Corresponding Author InformationAddress for reprints: Stephen Westaby, BSc, MS, PhD, Oxford Heart Centre, John Radcliffe Hospital, Oxford 0X9 3DU, United Kingdom.

Received 14 January 2008 ,Accepted 14 January 2008.

References 

  1. Despotis G, Avidan MS, Hogue CW. Mechanisms of hemostatic activation during extracorporeal circulation. Ann Thorac Surg. 2001;72:1821–1831
  2. Koch CG, Li L, Duncan AL, Mihaljevic T, Loop FD, Starr NJ, et al. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg. 2006;81:1650–1657
  3. Kuduvalli M, Oo AY, Newall N, Grayson AD, Jackson M, Desmond MJ, et al. Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2005;27:592–598
  4. de Smet AA, Joen MC, van Oeveren W, Roozendaal KJ, Harder MP, Eijsman L, et al. Increased anticoagulation during cardiopulmonary bypass by aprotinin. J Thorac Cardiovasc Surg. 1990;100:520–527
  5. Westaby S. Coagulation disturbances in profound hypothermia. Semin Thorac Cardiovasc Surg. 1997;9:246–256
  6. Wildevuur CR, Eijsman L, Roozendaal KJ, Harder MP, Chang M, van Oeveren W, et al. Platelet preservation during cardiopulmonary bypass with aprotinin. Eur J Cardiothorac Surg. 1989;3:533–538
  7. Westaby S. Aprotinin in perspective. Ann Thorac Surg. 1993;55:1033–1041
  8. Okita Y, Takamoto S, Ando M, et al. Coagulation in fibrinolysis system in aortic surgery under deep hypotheric circulatory arrest with aprotinin. Circulation. 1997;96(9 Suppl):11-376-81
  9. Westaby S, Forni A, Dunning J, Giannopoulos N, O'Regan D, Drossos G, et al. Aprotinin and bleeding in profoundly hypothermic perfusion. Eur J Cardiothoracic Surg. 1994;8:82–86
  10. Sundt TM, Saffitz JE, Stahl J, Murphy SF, Wareing TH, Stahl DJ. Renal dysfunction and intravascular coagulation after use of aprotinin in thoracic aortic operation employing hypothermic circulatory arrest. Ann Thorac Surg. 1993;55:1418–1424
  11. Royston D, Bidstrup BP, Taylor KM, Sapsford RN. Effect of aprotinin on need for blood transfusion after repeat open heart surgery. Lancet. 1987;2:1289–1291
  12. Lemmer JH, Dilling EW, Morton JR, Rich JB, Robicsek F, Bricker DL, et al. Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens. Ann Thorac Surg. 1996;62:1659–1667
  13. Cosgrove DM, Heric B, Lytle BW, Taylor PC, Novoa R, Golding LA, et al. Aprotinin therapy for reoperative myocardial revascularization: a placebo-controlled study. Ann Thorac Surg. 1992;54:1031–1036
  14. Levy JH, Pifarré R, Schaff HV, Breen JF, Chomka EV, Eldredge WJ, et al. A multicenter, double-blind, placebo-controlled trial of aprotinin for reducing blood loss and the requirement for donor-blood transfusion in patients undergoing repeat coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1994;107:543–551
  15. Smith PK, Muhlbaier LH. Aprotinin: safe and effective only with the full-dose regimen. Ann Thorac Surg. 1996;62:1575–1577
  16. Royston D. Intraoperative coronary thrombosis: can aprotinin be incriminated. J Cardiothorac Vasc Anesth. 1994;8:137–141
  17. Havel M, Grabenwoger F, Schneider J, Laufer G, Wollenek G, Owen A, et al. Aprotinin does not decrease early graft patency after coronary bypass grafting despite reducing postoperative bleeding and use of donated blood. J Thorac Cardiovasc Surg. 1994;107:807–810
  18. van der Meer J, Hillege HL, Ascoop CA, Dunselman PH, Mulder BJ, van Ommen GV, et al. Aprotinin in aorto-coronary bypass surgery: increased risk of vein graft occlusion and myocardial infarction? Supportive evidence from a retrospective study. Thromb Haemost. 1996;75:1–3
  19. Alderman EL, Levy HJ, Rich JB, Nili M, Vidne B, Schaff H, et al. Analyses of coronary graft patency after aprotinin use: results from the International Multicenter Aprotinin Graft Patency Experience (IMAGE) trial. J Thorac Cardiovasc Surg. 1998;116:716–730
  20. Mangano DT, Tudor IC, Dietzel C. The risk associated with aprotinin in cardiac surgery. N Engl J Med. 2006;354:353–365
  21. Royston D, van Haaften N, de Vooght P. Aprotinin: friend or foe? A review of recent medical literature. Eur J Anaesthesiol. 2007;24:6–14
  22. Furnary AP, Wu YX, Hiratzka LF, Grunkemeier GL, Page US. Aprotinin does not increase the risk of renal failure in cardiac surgery patients. Circulation. 2007;116(11 Suppl I):I127–I133
  23. Sedrakyan A, Atkins D, Treasure T. The risk of aprotinin: a conflict of evidence. Lancet. 2006;367:1376–1377
  24. Sedrakyan A, Treasure T, Elefteriades JA. Effect of aprotinin on clinical outcomes in coronary artery bypass surgery: a systematic review and meta analysis of randomized clinical trials. J Thorac Cardiovasc Surg. 2004;128:442–448
  25. Augoustides JGT. Fatal intraoperative thrombosis in contemporary adult thoracic aortic surgery requiring deep hypothermic circulatory arrest: observations from the literature 1993–2006. J Thorac Cardiovasc Surg. 2007;134:1069–1070

PII: S0022-5223(08)00033-0

doi: 10.1016/j.jtcvs.2008.01.002

The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 3 , Pages 487-491 , March 2008

Article Tools