Low dose Aprotinin as blood saver in open heart surgery

Abstract

Bleeding after open heart surgery is still a great concern for thesurgeon, especially when the surgical field has been revised accurately andhemostatic stitches and electrical cauterization have been usedextensively. Among non-surgical adjuncts, aprotinin has been reported asvery effective in reducing complications. At the time we started using thisdrug, we intended to test two different dosages lower than those reportedin the literature. We evaluated three groups of 18 patients: the first (A)received about 350 mg of aprotinin from the start of anesthesia up to theend of operation (140 mg in the priming of cardio-pulmonary bypass and 70mg/h i.v. during the procedure; the second (A/2) received half that dose(i.e. 70 mg and 35 mg, respectively), and the third (C) did not receiveaprotinin. We compared in these groups: postoperative bleeding, bloodtransfusions, red blood cells, hemoglobin, hematocrit, platelets. Theresults were good only in the A group: bleeding was reduced and fewtransfusions were required. The patients in the A/2 and C groups did notshow significant differences. From our observations we conclude thataprotinin is a useful adjunct, but has to be given in the proper dose.