HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alejandro Arís Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Casas, J. I. Articles by Fontcuberta, J. Search for Related Content PubMed PubMed Citation Articles by Casas, J. I. Articles by Fontcuberta, J.

J Thorac Cardiovasc Surg 1995;110:1107-1117
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

APROTININ VERSUS DESMOPRESSIN FOR PATIENTS UNDERGOING OPERATIONS WITH CARDIOPULMONARY BYPASS: A double-blind placebo-controlled study

Barcelona, Spain

Supported in part by Q. F. Bayer, Spain.

Received for publication Sept. 26, 1994. Accepted for publication March 15, 1995. Address for reprints: José Mateo, MD, Hematology Department, Hospital de Sant Pau, Av.P.Claret No. 167, 08025-Barcelona, Spain.

Abstract

Background. Aprotinin reduces blood loss in operations done with cardiopulmonary bypass, whereas the use of desmopressin remains controversial. We compared aprotinin, desmopressin, and placebo in a double-blind, randomized trial to evaluate bleeding and transfusion requirements. Methods and results.One hundred forty-nine patients (48 received aprotinin, 50 desmopressin, 51 placebo) were included. Blood loss and transfusion requirements were recorded and levels of Factor VIII coagulant activity, von Willebrand's factor, thrombin-antithrombin complexes, and D-dimer were measured. Overall blood loss was 195±146 ml/m ²in theaprotinin group, 400±192 ml/m ²in the desmopressingroup, and 489±361 ml/m ²in the placebo group (95% confidence intervals: difference between desmopressin and aprotinin 98 to 312 ml/m ², p<0.001; difference betweenplacebo and aprotinin 190 to 398 ml/m ², p<0.001). Twenty-six percent of patients treated with aprotinin, 66% of those treated with desmopressin, and 56% of those treated with placebo were given transfusion (95% confidence intervals: difference between aprotinin versus placebo plus desmopressin 51% to 71%, p<0.001). Fibrinolytic activation throughout cardiopulmonary bypass was markedly higher with placebo or desmopressin administration. D-dimer level correlated with overall blood loss in patients receiving desmopressin or placebo, but not in those receiving aprotinin.Conclusion. Aprotinin administration reduces blood loss and transfusion requirements in cardiopulmonary bypass. This benefit may be explained by a lower activation of fibrinolysis. (J THORAC CARDIOVASC SURG 1995;110:1107-17)

This article has been cited by other articles:

				J. R. Brown, N. J.O. Birkmeyer, and G. T. O'Connor Meta-Analysis Comparing the Effectiveness and Adverse Outcomes of Antifibrinolytic Agents in Cardiac Surgery Circulation, June 5, 2007; 115(22): 2801 - 2813. [Abstract] [Full Text] [PDF]

				P. M. Mannucci and M. Levi Prevention and Treatment of Major Blood Loss N. Engl. J. Med., May 31, 2007; 356(22): 2301 - 2311. [Full Text] [PDF]

				D. Fergusson, K. C. Glass, B. Hutton, and S. Shapiro Randomized controlled trials of aprotinin in cardiac surgery: could clinical equipoise have stopped the bleeding? Clinical Trials, June 1, 2005; 2(3): 218 - 232. [Abstract] [PDF]

				G. J. Despotis and L. T. Goodnough Management approaches to platelet-related microvascular bleeding in cardiothoracic surgery Ann. Thorac. Surg., August 1, 2000; 70(2): S20 - 32. [Abstract] [Full Text] [PDF]

				A. Aris, M. L. Camara, J. Montiel, L. J. Delgado, J. Galan, and H. Litvan Ministernotomy versus median sternotomy for aortic valve replacement: a prospective, randomized study Ann. Thorac. Surg., June 1, 1999; 67(6): 1583 - 1587. [Abstract] [Full Text] [PDF]

				T. B. Spanier, M. C. Oz, O. P. Minanov, R. Simantov, W. Kisiel, D. M. Stern, E. A. Rose, and A. M. Schmidt Heparinless cardiopulmonary bypass with active-site blocked factorIXa: A preliminary study on the dog J. Thorac. Cardiovasc. Surg., May 1, 1998; 115(5): 1179 - 1188. [Abstract] [Full Text] [PDF]

				T. K. Rosengart, W. DeBois, M. O'Hara, R. Helm, M. Gomez, S. J. Lang, N. Altorki, W. Ko, G. S. Hartman, O. W. Isom, et al. Retrograde Autologous Priming For Cardiopulmonary Bypass: A Safe And Effective Means Of Decreasing Hemodilution And Transfusion Requirements J. Thorac. Cardiovasc. Surg., February 1, 1998; 115(2): 426 - 439. [Abstract] [Full Text] [PDF]