THE IMPACT OF APROTININ ON CORONARY-ARTERY BYPASS GRAFT PATENCY

Study design: Aprotinin has recently been shown to reduce postoperativ e bleeding and transfusion requirements associated with coronary arter y bypass grafting. One concern with its use, however, is that it may h ave a deleterious effect on graft patency because it promotes hemostas is. Forty-seven patients undergoing coronary artery bypass grafting we re enrolled in a prospective, randomized double-blind trial of aprotin in to determine the effect of this agent on postoperative bleeding, tr ansfusion requirements, renal function, and graft patency. The study g roup was comprised of the 32 patients who underwent technically adequa te ultrafast CT scans 6 to 8 weeks postoperatively to determine graft patency. Sixteen patients received aprotinin (aprotinin group) and 16 received placebo (control group). Results: Demographic and operative d escriptors were comparable between groups. Postoperative mediastinal a nd chest tube drainage in the aprotinin group was significantly less t han that in the control group (722 vs 1,540 mL; p=0.0006) and the mean blood transfusion requirements were less, but this did not reach sign ificance (125 vs 297 mL; p=0.42). Analysis of graft patency by patient s revealed that 5 patients in the aprotinin group (31%) had at least o ne occluded graft, while none of the patients in the control group had an occluded graft (p=0.04). Analysis by graft revealed that 38 of 43 grafts placed in the aprotinin group were patent, while all 38 grafts placed in the placebo group were patent (88.4 vs 100%; p=0.057). There was no difference in the incidence of myocardial infarction, renal dy sfunction or hematologic indexes at discharge between the groups, or e vidence of other thrombotic complications. Conclusion: We conclude tha t high-dose aprotinin is effective in reducing hemorrhage after corona ry artery bypass grafting. However, its routine use should be approach ed cautiously due to its possible adverse effects on graft patency.