Efficacy of a High-Dose Aprotinin Regimen for Reducing Transfusion Requirements and Inflammatory Responses in Adult Cardiac Surgery

This study evaluated and compared the risks and effects to the inflammatory response of low- and high-dose aprotinin regimens. Between January and June 2006, patients scheduled for cardiac surgery using cardiopulmonary bypass were enrolled and randomly allocated to either low- ( n = 15) or high-dose ( n = 13) aprotinin groups. The incidences of mortality and adverse events were comparable in both groups. Post-operative creatinine levels and blood loss were not significantly different between the two groups. With the exception of platelets, the counts of transfused allogenic blood products were not significantly different between the groups. Interleukin (IL)-6, IL-10, soluble tumour necrosis factor II receptor, and interferon-γ levels increased in both groups compared with baseline, but no significant intergroup differences were detected. In conclusion, high- and low-dose aprotinin had similar effects in the reduction of mediastinal bleeding and attenuation of systemic inflammatory responses, and high-dose aprotinin therapy could be used without any increased adverse effects.

Platelet dysfunction after normothermic cardiopulmonary bypass in children: Effect of high-dose aprotinin

SummaryPlatelet dysfunction after cardiopulmonary bypass (CPB) can contribute to excessive post-operative bleeding. Most trials of the protective effect of aprotinin in this setting have involved hypothermic CPB, which is more deleterious for platelets than normothermic CPB.Here we investigated the effect of aprotinin on platelet function during normothermic CPB in pediatric patients. Twenty patients (9 newborns [<1 month old] and 11 infants [<36 month old]),weighting less than 15 kg and undergoing normothermic CPB (35–36°C) were randomly assigned to two equal groups,one of which received high-dose aprotinin.Platelet function was assessed by flow cytometry just before CPB and 5 minutes after heparin neutralization. F1+2 fragments were measured by ELISA before and 5 minutes after CPB. Platelet activation marker expression (CD62P and activated αIIbβ3) induced by ADP or TRAP was lower after CPB than before CPB, suggesting a deleterious effect of normothermic CPB on platelet function. Prothrombin fragment F1+2 levels increased after CPB. Aprotinin administration did not influence the level of prothrombin fragments or platelet marker expression measured in basal condition. However, after CPB, the capacity for platelet activation was higher in the aprotinin group, as shown by measuring CD62P expression afterTRAP activation (p=0.05).This study suggests that pediatric normothermic CPB causes platelet dysfunction, and that high-dose aprotinin has a protective effect.