The use of micro-dose aprotinin with continuous infusion in coronary artery bypass surgery

Background. To evaluate the efficacy of aprotinin at a dose far less than s tandard, Methods. Experimental design: Retrospective, case-control study, Setting: c ommunity-based, teaching hospital Patients: one hundred one patients undergoing primary, non-emergent, corona ry artery bypass during two, six-month periods were studied, Interventions: during the first period aprotinin was not administered, and these patients served as controls (n=52), During the second period all patients received aprotinin via a micro-dose regimen (n=49), Measures: postoperative bleeding and blood product usage served as determinants of efficacy, Results, A significant difference existed in postoperative bleeding with th e mean thoracic drain outputs being reduced in the aprotinin group both at 6 hours (p=0.0003) and in total (p=0.0004). This was further supported by s ignificantly higher hematocrits (p=0.03) on the first postoperative day in patients receiving aprotinin, Likewise, there was a significant reduction i n total blood product exposures (p=0.04) and platelet usage (p=0.02) in the aprotinin group with a tendency towards decreased red cell usage. Further, when all patients with a hematocrit less than or equal to 30% prior to byp ass were excluded, the significant reduction in total blood product exposur es persisted (p=0.04), and there was a significant reduction in red cell us age (p=0.04) with a trend towards decreased platelet usage (p=0.06) in the aprotinin group, Conclusions. Micro-dose aprotinin significantly reduces postoperative bleed ing and blood product usage in primary, non-emergent, CABG patients.