Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens.

@article{Lemmer1996AprotininFP,
  title={Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens.},
  author={J. Lemmer and E. Dilling and J. Morton and J. Rich and F. Robicsek and D. Bricker and C. Hantler and J. Copeland and J. Ochsner and P. Daily and C. Whitten and G. Noon and R. Maddi},
  journal={The Annals of thoracic surgery},
  year={1996},
  volume={62 6},
  pages={
          1659-67; discussion 1667-8
        }
}
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… Expand
Ultra-low dose aprotinin decreases transfusion requirements and is cost effective in coronary operations.
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These data support the routine use of aprotinin 1 million KIU in coronary artery bypass grafting with left internal mammary artery to reduce cost and transfusion requirements. Expand
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High and medium doses of aprotinin were well tolerated and reduced bleeding and transfusion requirements in patients submitted to coronary bypass surgery under the effects of aspirin. Expand
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TLDR
Concerns that aprotinin therapy is associated with increased mortality, myocardial infarction, or renal failure risk is not supported by data from published, randomized, placebo-controlled clinical trials. Expand
Full-Dose Aprotinin Use in Coronary Artery Bypass Graft Surgery: An Analysis of Perioperative Pharmacotherapy and Patient Outcomes
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TLDR
As the full kallikrein-inhibiting dose of aprotinin has been shown to be safe and effective, the current results support its use in both primary and repeat CABG surgery. Expand
Medical and Economic Impact of Aprotinin Use in Adult Cardiac Surgery
TLDR
Full-dose aprotinin is more effective than half- dose aProtinin in reducing bleeding and blood transfusion and appears to be less effective in stroke reduction than full-dose, particularly in high-risk patients. Expand
Aprotinin for Patients Exposed to Clopidogrel before Off-Pump Coronary Bypass
TLDR
In patients with unstable angina and recent clopidogrel exposure who are undergoing off-pump coronary artery bypass, intraoperative administration of low-dose aprotinin is recommended to reduce blood loss and transfusion requirements. Expand
Tranexamic Acid and Aprotinin Reduce Postoperative Bleeding and Transfusions During Primary Coronary Revascularization
TLDR
The data show that TA is equivalent to aprotinin for blood conservation in patients at risk of excessive post-CPB bleeding and transfusion therapy, and help to support the use of pharmacologic methods to improve clinically relevant indicators of blood conservation for primary CPB procedures. Expand
The efficacy and safety of aprotinin use in cardiac surgery.
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  • Medicine
  • The Annals of thoracic surgery
  • 1998
TLDR
Given the risks and costs associated with excessive bleeding and transfusions and the limited supply of banked blood, aprotinin represents an important and safe approach to blood conservation. Expand
The effect of two different doses of aprotinin on hemostasis in cardiopulmonary bypass surgery: similar transfusion requirements and blood loss.
TLDR
Both dosages of aprotinin were equally effective in reducing blood loss and transfusion requirements and the former should be recommended for patients undergoing cardiopulmonary bypass surgery. Expand
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References

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Aprotinin for coronary artery bypass grafting: effect on postoperative renal function.
TLDR
Under the conditions described, aprotinin use does not appear to be associated with a significant risk of serious renal toxicity, and the difference between the two groups was not statistically significant. Expand
Influence of aprotinin on early graft thrombosis in patients undergoing myocardial revascularization.
TLDR
It is suggested that perioperative myocardial infraction secondary to aprotinin-induced native coronary artery or conduit thrombosis is not increased by aProtinin in patients undergoing primaryMyocardial revascularization. Expand
Aprotinin for coronary bypass operations: efficacy, safety, and influence on early saphenous vein graft patency. A multicenter, randomized, double-blind, placebo-controlled study.
TLDR
In this study, aprotinin was effective in reducing bleeding and blood product transfusion rates, and its use was not associated with an increase in complications. Expand
Aprotinin significantly decreases bleeding and transfusion requirements in patients receiving aspirin and undergoing cardiac operations.
TLDR
High-dose aprotinin significantly reduces blood loss and red blood cell transfusions in patients receiving aspirin who undergo cardiac operations. Expand
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.
TLDR
It is demonstrated that high- and low-dose aprotinin significantly reduces the requirement for donor-blood transfusion in repeat CABG patients without increasing the risk for perioperative MI. Expand
Aprotinin therapy for reoperative myocardial revascularization: a placebo-controlled study.
TLDR
It is concluded that aprotinin is extremely effective in reducing bleeding and transfusion requirements and may increase the risk of graft thrombosis. Expand
Effects of high-dose aprotinin on renal function in aortocoronary bypass grafting.
TLDR
Patients with normal renal function preoperatively--as were included in this study--are able to compensate for both the perioperative renal dysfunction caused by the extracorporeal circulation and the additional tubular damage due to aprotinin. Expand
Half-dose aprotinin preserves hemostatic function in patients undergoing bypass operations.
TLDR
It is shown that half-dose aprotinin significantly inhibits fibrinolysis and prevents postoperative abnormal bleeding time in cardiac surgical patients. Expand
Effect of aprotinin (Trasylol) on aorta-coronary bypass graft patency.
TLDR
In this study, high-dose aprotinin did not result in early saphenous vein graft occlusion after aorta-coronary bypass operations, further evidence that aProtinin reduces hemostatic derangement during cardiopulmonary bypass without creating a "prothrombotic" situation. Expand
Aprotinin in elective primary bypass surgery. Graft patency and clinical efficacy.
TLDR
A randomized double-blind group comparison study was carried out in male patients elected for primary bypass surgery to investigate a possible influence on graft patency, and blood loss within 6 h postoperatively was reduced by 58.5% in the aprotinin group. Expand
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