EFFICACY OF APROTININ WITH VARIOUS ANTICOAGULANT AGENTS IN CARDIOPULMONARY BYPASS

Background. Aprotinin has recently been approved for clinical use in c ardiopulmonary bypass. Although unfractionated heparin has been the on ly anticoagulant widely used for cardiopulmonary bypass, disadvantages involving heparin have led to ongoing investigations of alternative a nticoagulant agents. Methods. The objective of this study was to evalu ate the efficacy of aprotinin in combination with other anticoagulant agents, specifically low molecular weight heparin and recombinant hiru din, using a dog model of cardiopulmonary bypass. Results. The blood c onservation resulting from the use of aprotinin was observed only with unfractionated heparin. Efficacy of anticoagulation as measured by pr otein deposits in the bypass circuit filter revealed an unexpected red uction in the quantity of deposits when aprotinin was used in combinat ion with low molecular weight heparin. Conclusions. As alternative ant icoagulant agents are sought, the potential benefits of aprotinin in t he reduction of operative blood loss must be evaluated independently f or each anticoagulant agent.