The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 897-903 , October 2009

A comparison before and after aprotinin was suspended in cardiac surgery: Different results in the real world from a single cardiac center in China

  • Xianqiang Wang, MD

      Affiliations

    • Department of Cardiovascular Surgery and Research Center for Cardiovascular Regenerative Medicine, Beijing, China
    • X.W. and Z.Z contributed equally to this article.
    • ,
  • Zhe Zheng, MD

      Affiliations

    • Department of Cardiovascular Surgery and Research Center for Cardiovascular Regenerative Medicine, Beijing, China
    • X.W. and Z.Z contributed equally to this article.
    • ,
  • Hushan Ao, MD

      Affiliations

    • Department of Anesthesia, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    • ,
  • Shiju Zhang, MD

      Affiliations

    • Department of Cardiovascular Surgery and Research Center for Cardiovascular Regenerative Medicine, Beijing, China
    • ,
  • Yang Wang, MD

      Affiliations

    • Department of Cardiovascular Surgery and Research Center for Cardiovascular Regenerative Medicine, Beijing, China
    • ,
  • Hao Zhang, MD

      Affiliations

    • Department of Cardiovascular Surgery and Research Center for Cardiovascular Regenerative Medicine, Beijing, China
    • ,
  • Lihuan Li, MD

      Affiliations

    • Department of Anesthesia, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    • ,
  • Shengshou Hu, MD

      Affiliations

    • Department of Cardiovascular Surgery and Research Center for Cardiovascular Regenerative Medicine, Beijing, China
    • Corresponding Author InformationAddress for reprints: Shengshou Hu, MD, Chief, Department of Surgery; Director, Research Center for Cardiovascular Regenerative Medicine, Cardiovascular Institute and Fuwai Hospital; Chinese Academy of Medical Science and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing 100037, People's Republic of China.

Received 4 December 2008 ,Revised 18 February 2009 ,Accepted 9 March 2009.

References 

  1. 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
  2. Havel M, Grabenwöger F, Schneider J. Aprotinin does not decrease early graft patency after coronary artery bypass grafting despite reducing postoperative bleeding and use of donated blood. J Thorac Cardiovasc Surg. 1994;107:807–810
  3. Hayashida N, Isomura T, Sato T, Maruyama H, Kosuga K, Aoyagi S. Effects of minimal-dose aprotinin on coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1997;114:261–269
  4. Murkin JM. Attenuation of neurologic injury during cardiac surgery. Ann Thorac Surg. 2001;72:S1838–S1844
  5. Sedrakyan A, Treasure T, Elefteriades JA. Efect of aprotinin on clinical outcomes in coronary artery bypass graft surgery: a systematic review and meta-analysis of randomized clinical trials. J Thorac Cardiovasc Surg. 2004;128:442–448
  6. Poston RS, White C, Gu J. Aprotinin shows both hemostatic and antithrombotic effects during off-pump coronary artery bypass grafting. Ann Thorac Surg. 2006;81:104–110
  7. Royston D, Levy JH, Fitch J. Full-dose aprotinin use in coronary artery bypass graft surgery: an analysis of perioperative pharmacotherapy and patient outcomes. Anesth Analg. 2006;103:1082–1088
  8. Ronald A, Dunning J. Does use of aprotinin decrease the incidence of stroke and neurological complications in adult patients undergoing cardiac surgery?. Interact Cardiovasc Thorac Surg. 2006;5:767–773
  9. Mangano DT, Tudor IC, Dietzel C. Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation. The risk associated with aprotinin in cardiac surgery. N Engl J Med. 2006;354:353–365
  10. Mangano DT, Miao Y, Vuylsteke A, Tudor IC, Juneja R, Filipescu D, et al. Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery. JAMA. 2007;297:471–479
  11. Kertai MD, Varga KS, Royston D, London MJ, Szabolcs Z, Grebenik CR, et al. Aprotinin and perioperative complications in cardiac surgery. J Cardiovasc Surg (Torino). 2007;48:761–772
  12. Mouton R, Finch D, Davies I, Binks A, Zacharowski K. Effect of aprotinin on renal dysfunction in patients undergoing on-pump and off-pump cardiac surgery: a retrospective observational study. Lancet. 2008;371:475–482
  13. Koster A, Buz S, Krabatsch T, Dehmel F, Kuppe H, Hetzer R, et al. High-dose aprotinin effectively reduces blood loss during on-pump coronary artery bypass grafting with bivalirudin anticoagulation. J Thorac Cardiovasc Surg. 2008;135:685–687
  14. Pagano D, Howell NJ, Freemantle N, Cunningham D, Bonser RS, Graham TR, et al. Bleeding in cardiac surgery: the use of aprotinin does not affect survival. J Thorac Cardiovasc Surg. 2008;135:495–502
  15. Schneeweiss S, Seeger JD, Landon J, Walker AM. Aprotinin during coronary-artery bypass grafting and risk of death. N Engl J Med. 2008;358:771–783
  16. Shaw AD, Stafford-Smith M, White WD, Phllips-Bute B, Swaminathan M, Milano C, et al. The effect of aprotinin on outcome after coronary-artery bypass grafting. N Engl J Med. 2008;358:784–793
  17. Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med. 2008;358:2319–2331
  18. Kain K, Catto AJ, Grant PJ. Impaired fibrinolysis and increased fibrinogen levels in South Asian subjects. Atherosclerosis. 2001;156:457–461
  19. Forouhi NG, Rumley A, Lowe GD. Specific elevation in plasma tissue plasminogen activator antigen concentrations in South Asians relative to Europeans. Blood Coagul Fibrinolysis. 2003;14:755–760
  20. El Rouby S, Mestres CA, LaDuca FM, Zucker ML. Racial and ethnic differences in warfarin response. J Heart Valve Dis. 2004;13:15–21
  21. Yu HY, Liu CH, Chen YS, Wang SS, Chu SH, Lin FY. Relationship of international normalized ratio to bleeding and thromboembolism rates in Taiwanese patients receiving vitamin K antagonist after mechanical valve replacement. J Formos Med Assoc. 2005;104:236–243
  22. McEvoy MD, Reeves ST, Reves JG, Spinale FG. Aprotinin in cardiac surgery: a review of conventional and novel mechanisms of action. Anesth Analg. 2007;105:949–962
  23. Khan TA, Bianchi C, Voisine P. Reduction of myocardial reperfusion injury by aprotinin after regional ischemia and cardioplegic arrest. J Thorac Cardiovasc Surg. 2004;128:602–608
  24. Lazar HL, Bao Y, Tanzillo L, O'Gara P, Reardon D, Price D, et al. Aprotinin decreases ischemic damage during coronary revascularization. J Card Surg. 2005;20:519–523
  25. Kunt AS, Darcin OT, Aydin S, Demir D, Selli C, Andac MH. Mini-dose pump-prime aprotinin inhibited enhanced fibrinolytic activity and reduced blood loss and transfusion requirements after coronary artery bypass surgery. J Thromb Thrombolysis. 2005;19:197–200
  26. Erdogan M, Kalaycioglu S, Iriz E. Protective effect of aprotinin against lung damage in patients undergoing CABG surgery. Acta Cardiol. 2005;60:367–372

 The study was funded by Key Projects in the National Science & Technology Pillar Program during the Eleventh Five-year Plan Period (2006BAI01A09) and Key Projects of Beijing Municipal Science & Technology Commission (D0906004040391).

PII: S0022-5223(09)00415-2

doi: 10.1016/j.jtcvs.2009.03.021

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 897-903 , October 2009

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