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Aprotinin reduces bleeding and blood product use in patients treated with clopidogrel before coronary artery bypass grafting.
Ann Thorac Surg. 2005 Sep; 80(3):922-7.AT

Abstract

BACKGROUND

An increased proportion of patients undergoing urgent coronary artery bypass graft surgery (CABG) is being treated with clopidogrel, an irreversible platelet inhibitor. Clopidogrel in combination with aspirin is known to augment bleeding, transfusion requirements, and reoperation rates after CABG. Aprotinin, a protease inhibitor, is approved for use in cardiac surgery to reduce bleeding. The aim of this study was to investigate whether or not intraoperative use of aprotinin decreases bleeding and number of transfusions after CABG in patients treated with clopidogrel less than 5 days before surgery.

METHODS

We retrospectively reviewed the medical records of all consecutive patients, with preoperative clopidogrel exposure less than 5 days before surgery, who underwent urgent CABG at our institution during 1 year (n = 33). Eighteen patients received a full-dose aprotinin regime intraoperatively whereas 15 patients not receiving aprotinin served as a control group.

RESULTS

The two groups were comparable with respect to baseline characteristics and operative data. Mean postoperative bleeding was 710 mL (95% confidence interval [CI]: 560 to 860) in the aprotinin group versus 1,210 mL (95% CI: 860 to 1550) in the control group (p = 0.004). The aprotinin group received fewer transfusions of packed red blood cells (0.9 U, 95% CI: 0.1 to 1.7, versus 2.7 U, 95% CI: 1.4 to 4.1; p = 0.01), platelets (0.1 U, 95% CI: 0 to 0.3, versus 0.6 U, 0.2 to 0.9; p = 0.02), and fewer blood product units (1.1 U, 95% CI: 0.1 to 2.0, versus 3.7 U, 95% CI: 2.1 to 5.4; p = 0.002). There were 3 reoperations for bleeding, all in the control group (p = 0.05).

CONCLUSIONS

Aprotinin reduces bleeding, transfusion requirements of packed red blood cells, platelets, and total blood units in patients on clopidogrel undergoing urgent CABG.

Authors+Show Affiliations

Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16122456

Citation

Lindvall, Gabriella, et al. "Aprotinin Reduces Bleeding and Blood Product Use in Patients Treated With Clopidogrel Before Coronary Artery Bypass Grafting." The Annals of Thoracic Surgery, vol. 80, no. 3, 2005, pp. 922-7.
Lindvall G, Sartipy U, van der Linden J. Aprotinin reduces bleeding and blood product use in patients treated with clopidogrel before coronary artery bypass grafting. Ann Thorac Surg. 2005;80(3):922-7.
Lindvall, G., Sartipy, U., & van der Linden, J. (2005). Aprotinin reduces bleeding and blood product use in patients treated with clopidogrel before coronary artery bypass grafting. The Annals of Thoracic Surgery, 80(3), 922-7.
Lindvall G, Sartipy U, van der Linden J. Aprotinin Reduces Bleeding and Blood Product Use in Patients Treated With Clopidogrel Before Coronary Artery Bypass Grafting. Ann Thorac Surg. 2005;80(3):922-7. PubMed PMID: 16122456.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aprotinin reduces bleeding and blood product use in patients treated with clopidogrel before coronary artery bypass grafting. AU - Lindvall,Gabriella, AU - Sartipy,Ulrik, AU - van der Linden,Jan, PY - 2005/01/05/received PY - 2005/03/10/revised PY - 2005/03/18/accepted PY - 2005/8/27/pubmed PY - 2006/9/19/medline PY - 2005/8/27/entrez SP - 922 EP - 7 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 80 IS - 3 N2 - BACKGROUND: An increased proportion of patients undergoing urgent coronary artery bypass graft surgery (CABG) is being treated with clopidogrel, an irreversible platelet inhibitor. Clopidogrel in combination with aspirin is known to augment bleeding, transfusion requirements, and reoperation rates after CABG. Aprotinin, a protease inhibitor, is approved for use in cardiac surgery to reduce bleeding. The aim of this study was to investigate whether or not intraoperative use of aprotinin decreases bleeding and number of transfusions after CABG in patients treated with clopidogrel less than 5 days before surgery. METHODS: We retrospectively reviewed the medical records of all consecutive patients, with preoperative clopidogrel exposure less than 5 days before surgery, who underwent urgent CABG at our institution during 1 year (n = 33). Eighteen patients received a full-dose aprotinin regime intraoperatively whereas 15 patients not receiving aprotinin served as a control group. RESULTS: The two groups were comparable with respect to baseline characteristics and operative data. Mean postoperative bleeding was 710 mL (95% confidence interval [CI]: 560 to 860) in the aprotinin group versus 1,210 mL (95% CI: 860 to 1550) in the control group (p = 0.004). The aprotinin group received fewer transfusions of packed red blood cells (0.9 U, 95% CI: 0.1 to 1.7, versus 2.7 U, 95% CI: 1.4 to 4.1; p = 0.01), platelets (0.1 U, 95% CI: 0 to 0.3, versus 0.6 U, 0.2 to 0.9; p = 0.02), and fewer blood product units (1.1 U, 95% CI: 0.1 to 2.0, versus 3.7 U, 95% CI: 2.1 to 5.4; p = 0.002). There were 3 reoperations for bleeding, all in the control group (p = 0.05). CONCLUSIONS: Aprotinin reduces bleeding, transfusion requirements of packed red blood cells, platelets, and total blood units in patients on clopidogrel undergoing urgent CABG. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/16122456/Aprotinin_reduces_bleeding_and_blood_product_use_in_patients_treated_with_clopidogrel_before_coronary_artery_bypass_grafting_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(05)00539-4 DB - PRIME DP - Unbound Medicine ER -