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The Annals of Thoracic Surgery, Vol 51, 936-941, Copyright © 1991 by The Society of Thoracic Surgeons
MP Harder, L Eijsman, KJ Roozendaal, W van Oeveren and CR Wildevuur
To determine whether aprotinin can provide a significant improvement of
hemostasis in cardiopulmonary bypass using a membrane oxygenator, we tested
this drug in a prospective, randomized, double-blind, placebo- controlled
clinical trial. The subjects were 80 male patients undergoing
cardiopulmonary bypass for coronary artery bypass grafting. Forty patients
received aprotinin and 40 patients served as placebo controls. Aprotinin (4
x 10(6) KIU) was given as a continuous infusion, starting before operation
and continuing until after cardiopulmonary bypass; additionally, 2 x 10(6)
KIU aprotinin was added to the pump prime. Intraoperative and postoperative
bleeding, respectively two thirds and one third of the total perioperative
blood loss, were both significantly reduced in the aprotinin-treated group
(p less than 0.01). The total average perioperative blood loss, corrected
to a hemoglobin concentration of 7 mmol/L, was 550 mL in the aprotinin-
treated patients versus 900 mL in the control patients. This reduction in
blood loss, furthermore, significantly decreased the amount of
postoperative blood transfusions (p less than 0.05) and increased the
percentage of patients who did not receive postoperative donor blood from
42% to 68%. Aprotinin increased the activated clotting time significantly
during cardiopulmonary bypass, which led to a reduction in heparin usage.
The improved hemostasis during operation, despite the prolonged activated
clotting time, might even abolish the need for heparin conversion with
protamine at the end of cardiopulmonary bypass, thus allowing retransfusion
through cardiotomy suction to be continued, which saves the blood that is
currently lost with vacuum suction.
ARTICLES
Aprotinin reduces intraoperative and postoperative blood loss in membrane oxygenator cardiopulmonary bypass
Department of Cardiopulmonary Surgery, University Hospital, Groningen, The Netherlands.
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