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J Thorac Cardiovasc Surg 2008;135:685-687
© 2008 The American Association for Thoracic Surgery

Brief Communication

High-dose aprotinin effectively reduces blood loss during on-pump coronary artery bypass grafting with bivalirudin anticoagulation

^a Department of Anesthesia, Deutsches Herzzentrum, Berlin, Germany
^b Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany
^c Department of Perfusion, Deutsches Herzzentrum, Berlin, Germany
^d Department of Anesthesia, Duke University Medical Center, Durham, NC
^e Gaston Memorial Hospital, Gastonia, NC

Received for publication July 10, 2007; revisions received July 31, 2007; accepted for publication September 7, 2007.

^_* Address for reprints: Andreas Koster, MD, Deutsches Herzzentum Berlin, Augustenburger Platz 1, D-13353 Berlin. (Email: koster@dhzb.de).

The first 20% of the full text of this article appears below.

Bivalirudin is a short-acting direct thrombin inhibitor that is increasingly used for anticoagulation during cardiac surgery in patients with heparin-induced thrombocytopenia (HIT).¹ During cardiopulmonary bypass (CPB) with heparin anticoagulation, aprotinin reduces hemostatic activation, inflammatory response, perioperative blood loss, and transfusion requirements. The current investigation was performed to assess the effects of aprotinin when bivalirudin is used for anticoagulation during CPB.

Materials and Methods

After approval by the German Ministry for Drug Safety and the local ethics committee and informed consent was obtained, 14 patients scheduled for first-time elective coronary artery bypass grafting (CABG) were enrolled in this prospective single-center investigation. Patients were randomized to 2 groups with 7 patients each: 1 group with bivalirudin anticoagulation only and 1 group with bivalirudin and aprotinin. All patients had normal renal function, a left ventricular ejection fraction of more than 30%, and antiplatelet therapy discontinued 5 days before surgery. Bivalirudin dosing and CPB management were performed as described before using closed CPB systems without cardiotomy suction.² Aprotinin was . . . [Full Text of this Article]

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