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PubMed · 15239552

Aprotinin: a pharmacologic overview.

Jerrold H Levy·Edward Sypniewski
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Abstract

Aprotinin is a polypeptide with serine protease inhibitory activity of key enzymes associated with inflammatory, fibrinolytic, and hemostatic pathways. The drug binds directly to the fibrinolytic plasmin at the lower plasmin-inhibiting dose (plasma concentration, 137 KIU/mL), and the inflammatory mediator, kallikrein, using the higher kallikrein-inhibiting dose (plasma concentration, >250 KIU/mL). Aprotinin inhibits platelet glycoprotein loss (GpIb and GpIIb/IIIa receptors) associated with cardiopulmonary bypass and has been described as platelet sparing. Current literature supports direct anti-inflammatory effects through modulation of neutrophil activation, attachment, and transmigration, with resultant blunting in the rise of proinflammatory cytokine levels and deleterious tissue damaging enzymes. The pharmacologic properties of aprotinin may lead clinicians to consider this therapy for use as a hemostatic and anti-inflammatory agent in surgeries beyond its established use in coronary artery bypass graft surgery.

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AprotininBlood Loss, SurgicalHemostaticsHumansJournal ArticleReview

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BibTeXRIS

Jerrold H Levy, Edward Sypniewski. 2004. Aprotinin: a pharmacologic overview.. https://doi.org/10.3928/0147-7447-20040602-05

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PubMed2007

Ultra-low dose aprotinin effects on reducing the need for blood transfusion in cardiac surgery.

OBJECTIVE: To assess the effects of ultra-low dose one million kallikrein inhibitor units (KIU) of aprotinin on bleeding and the need for transfusion after cardiac surgery. METHODS: We carried out this randomized clinical trial on 162 cardiac surgery patients in Shahid Madani Hospital, Tabriz, Iran from April 2004 to December 2005. The patients were randomly divided into 2 groups of 81 individuals. In the aprotinin group, 0.5 million KIU infused before and 0.5 million KIU during cardiopulmonary bypass. In the placebo group, 100 ml normal saline was infused as above. The need to use fresh frozen plasma (FFP), packed red blood cells (PRBCs) transfusion during, after operation, the rate of chest tubes drainage at 6, 12 and 24 hours after surgery were measured in 2 groups. RESULTS: Chest tubes drainage at 6 hours after surgery was 190 +/- 24 ml in the aprotinin group and 266 +/- 33 ml in the placebo group (p=0.066). The amount of bleeding at 12 and 24 hours was significantly different between 2 groups (p=0.048, p=0.009). The frequency of blood products transfusion in the aprotinin group was 68% and in the placebo group was 75% (p=0.02). The number of PRBCs and FFP units transfused were significantly lower in the aprotinin group (p=0.000, p=0.005). Total amount of blood and products transfusion in the aprotinin group was 2.56 +/- 0.27 units and in placebo group it was 4.37 +/- 0.27 units (p=0.0001). CONCLUSION: Results indicate that the use of one million KIU of aprotinin in cardiac surgery is effective in reducing postoperative bleeding and transfusion requirements.

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PubMed2006

Aprotinin; friend or foe? A review of recent medical literature.

Recent articles published in peer review journals have questioned the safety of using aprotinin in patients having heart surgery. Also, evidence has been published to suggest an increase in renal events in patients given aprotinin when compared to those where tranexamic acid was used. The present review will focus principally on the first of these articles in relation to previously published data and experience.

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