Mr. Terrell et al., EFFICACY OF APROTININ WITH VARIOUS ANTICOAGULANT AGENTS IN CARDIOPULMONARY BYPASS, The Annals of thoracic surgery, 62(2), 1996, pp. 506-511
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.