INFLUENCE OF APROTININ ON EARLY GRAFT THROMBOSIS IN PATIENTS UNDERGOING MYOCARDIAL REVASCULARIZATION

One hundred sixty-five patients undergoing primary myocardial revascul arization were prospectively entered into a randomized, double-blind, placebo-controlled study, in a single institution, in order to determi ne the influence of high- and low-dose aprotinin application on early coronary artery bypass graft patency. All patients were operated on by the same team and the three treatment groups were comparable in all d emographic data and surgical variables. Postoperative chest tube drain age and transfusion requirements were significantly reduced in patient s receiving high or low doses of aprotinin. In all patients vein and i nternal mammary artery graft patency was assessed by control coronary angiograms 4 to 15 days (median 8.2 days) postoperatively. In the high -dose aprotinin group, 140 of 142 vein grafts and in the low-dose apro tinin group all of the 128 vein grafts were patent compared with 138 o f 139 in the placebo group. The difference was not statistically signi ficant (P > 0.05). All pedicled internal mammary artery grafts were pa tent in the three treatment groups. The prevalence of perioperative my ocardial infarction was evaluated by serial creatine kinase-myocardial band (CK-MB) isoenzyme measurements and by electrocardiographic recor dings. No additional changes that could be attributed to aprotinin wer e observed. In conclusion, these results suggest that perioperative my ocardial infarction secondary to aprotinin-induced native coronary art ery or conduit thrombosis is not increased by aprotinin in patients un dergoing primary myocardial revascularization.