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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 705-711, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
J Boldt, C Knothe, B Zickmann, N Wege, F Dapper and G Hempelmann
Only a few studies have reported on the effects of aprotinin in pediatric
cardiac surgery, and the correct dose is controversial. In a prospective,
randomized study, three groups of children weighing less than 20 kg were
investigated. In group 1 (n = 14): aprotinin 20,000 U/kg was given after
induction of anesthesia, 20,000 U/kg was added to the prime, and another
20,000 U/kg was given every hour of cardiopulmonary bypass (low-dose
regimen). In group 2 (n = 14) aprotinin 35,000 U/kg was given after
induction followed by an infusion of 10,000 U/kg.min until the end of the
operation and 35,000 U/kg was added to the prime (high-dose regimen). In
group 3 (n = 14) no aprotinin was used (control). Platelet function was
evaluated by aggregometry (maximum platelet aggregation, maximum gradient
of platelet aggregation) by means of turbidometric technique (inductors:
adenosine diphosphate, collagen, and epinephrine) before and after
cardiopulmonary bypass until the first postoperative day. Platelet
aggregation was significantly reduced during and after bypass, values
ranging from -29% to -54% (maximum aggregation) and -25% to -75% (maximum
gradient of aggregation) with regard to baseline values. In the further
postoperative course, platelet function recovered and mostly exceeded
baseline values on the first postoperative day. Platelet aggregation
variables were without any differences among aprotinin-treated and control
patients. Blood loss was similar for all three groups and added up to
approximately 28 ml/kg until the first postoperative day. The use of packed
red cells was also comparable for the three groups, whereas the use of
fresh frozen plasma was highest in group 1 (1680 ml until the first
postoperative day). We conclude from this study that aprotinin did not
improve platelet function and did nor reduce blood loss or the need for
homologous blood transfusion in pediatric cardiac surgery, regardless of
whether a low-dose or a high- dose regimen was used.
ARTICLES
Comparison of two aprotinin dosage regimens in pediatric patients having cardiac operations. Influence on platelet function and blood loss
Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig- University Giessen, Germany.
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