EFFECT OF REDUCED APROTININ DOSAGE ON BLOOD-LOSS AND USE OF BLOOD PRODUCTS IN PATIENTS UNDERGOING CARDIOPULMONARY BYPASS

High-dose aprotinin reduces bleeding after cardiac surgery, but has al so evoked concern with regard to potential side effects and hospital c osts. To evaluate the effects of reduced-dose aprotinin on blood loss and need for blood transfusion, 40 patients undergoing myocardial reva scularization were studied (double-blind, placebo-controlled). Postope rative bleeding was reduced by 40% and erythrocyte infusion by 85% in the group given 3x10(6) KIU aprotinin (1x10(6) as a loading dose befor e cardiopulmonary bypass, 1 x 10(6) in the priming volume and 2.5 x 10 (5)/hour intraoperatively) Aprotinin concentrations during the operati on were monitored and maintained above the required level. There were no adverse effects of the drug. Hospital expenditure on blood products was reduced by 51% when aprotinin was used. Our study suggests that a protinin in reduced dosage diminishes bleeding and requirements for bl ood products, and that it should be given before, during and after car diopulmonary bypass.