Dj. Goldstein et al., SAFETY AND EFFICACY OF APROTININ UNDER CONDITIONS OF DEEP HYPOTHERMIAAND CIRCULATORY ARREST, Journal of thoracic and cardiovascular surgery, 110(6), 1995, pp. 1615-1621
Aprotinin has been successfully used to reduce blood loss and blood pr
oduct requirements in patients undergoing primary and reoperative card
iac operations. Its safety and efficacy during profound hypothermia an
d circulatory arrest have been questioned, however. A retrospective re
view compared 24 patients who received aprotinin during complex aortic
procedures under profound hypothermia and circulatory arrest with 24
age-matched patients undergoing similar procedures without aprotinin.
Activated clotting time was maintained at longer than 500 seconds (kao
lin activating agent) or longer than 750 seconds (celite). We observed
no statistically significant difference in the incidence of neurologi
c events (p not significant) or myocardial infarctions (p not signific
ant), and there was a trend toward reduced in-hospital mortality rate
in aprotinin-treated patients. A higher incidence of postoperative ren
al dysfunction was encountered in aprotinin-treated patients. Aprotini
n recipients had a significant reduction in requirements for postopera
tive homologous erythrocytes (p = 0.01). We conclude that aprotinin ma
y be safely and effectively used in patients undergoing deep hypotherm
ia and circulatory arrest.