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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 364-372, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BP Bidstrup, D Royston, RN Sapsford and KM Taylor
The effect of high dose aprotinin (Trasylol) was evaluated in three groups
of patients undergoing cardiopulmonary bypass. In a prospective,
placebo-controlled, double-blind study, 80 patients having primary
aorta-coronary bypass grafting received aprotinin (700 mg approximately) or
saline placebo from the beginning of the procedure until skin closure.
Standardized anesthetic, perfusion, and surgical techniques were used. The
total loss from the thoracic drains was significantly reduced in the
aprotinin group as compared with the loss in the placebo group (309 +/- 133
ml versus 573 +/- 166 ml, p less than 0.01; mean +/- standard deviation).
There was a threefold difference in the total hemoglobin loss into the
chest drains (aprotinin 12.0 +/- 12.6 gm versus placebo 37.7 +/- 18.3 gm).
Patients of the aprotinin group received remarkably less bank blood
postoperatively: 13 units total compared with 75 units. Of the 40 patients
in the aprotinin group, 32 received no bank blood compared with 2 of 37
patients in the placebo group. Venous hemoglobin levels preoperatively, on
day 1, and on day 7 postoperatively did not differ between the groups. At
day 7 the values were 13.1 +/- 1.4 gm/dl versus 12.5 +/- 1.2 gm/dl in the
aprotinin group and the placebo group, respectively. Platelet counts
determined at fixed times perioperatively did not differ between the two
groups. In contrast, template bleeding time measured in 32 study patients
was distinctly different between groups, with a postoperative rise of 6.2
+/- 2.1 minutes in the placebo group opposed to only 1.5 +/- 1.1 minutes in
the aprotinin group.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Reduction in blood loss and blood use after cardiopulmonary bypass with high dose aprotinin (Trasylol)
Humana Hospital Wellington, England.
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B. E. Miller, S. R. Tosone, V. K.H. Tam, K. R. Kanter, N. A. Guzzetta, J. M. Bailey, and J. H. Levy Hematologic and economic impact of aprotinin in reoperative pediatric cardiac operations Ann. Thorac. Surg., August 1, 1998; 66(2): 535 - 540. [Abstract] [Full Text] [PDF]
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P. M. Mannucci Hemostatic Drugs N. Engl. J. Med., July 23, 1998; 339(4): 245 - 253. [Full Text] [PDF]
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P. Pouard Review of Efficacy Parameters Ann. Thorac. Surg., June 1, 1998; 65(90060): S40 - 44. [Abstract] [Full Text] [PDF]
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H. Mossinger and W. Dietrich Activation of Hemostasis During Cardiopulmonary Bypass and Pediatric Aprotinin Dosage Ann. Thorac. Surg., June 1, 1998; 65(90060): S45 - 51. [Abstract] [Full Text] [PDF]
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A. M. Scheule, W. Beierlein, H. P. Wendel, F. S. Eckstein, M. K. Heinemann, and G. Ziemer Fibrin sealant, aprotinin, and immune response in children undergoing operations for congenital heart disease J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 883 - 889. [Abstract] [Full Text] [PDF]
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