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2006 by the Societe Internationale de Chirurgie World J Surg (2006) 30: 11081114Published Online: 27 April 2006 DOI: 10.1007/s00268-005-0619-3Effects of Half-dose Aprotinin in Off-pump
Coronary Artery Bypass GraftingMinxin Wei, MD, PhD,1,5 Kaitao Jian, MD,1 Zhipeng Guo, MD,1 Peijun Li, MD,2Jiange Han, MD,3 Zhong Cai, MD,4 Matti Tarkka, MD, PhD51Department of Cardiac Surgery, Tianjin Chest Hospital, #93 Xi an Dao, Heping District, 300051 Tianjin,Peoples Republic of China2Intensive Care Unit, Tianjin Chest Hospital, #93 Xi an Dao, Heping District, 300051 Tianjin,Peoples Republic of China3Department of Anesthesiology, Tianjin Chest Hospital, #93 Xi an Dao, Heping District, 300051 Tianjin,Peoples Republic of China4Department of Clinical Laboratory, Tianjin Chest Hospital, #93 Xi an Dao, Heping District, 300051 Tianjin,Peoples Republic of China5Heart Center, Tampere University Hospital, Tampere, FinlandAbstractObjective: The effects of half-dose aprotinin in off-pump coronary artery bypass (OPCAB) surgeryhave not yet been described. The present prospective study was designed to investigate itseffects in OPCAB.Methods: Seventy-six patients were randomized into two groups, receiving aprotinin (1 106 Kallikrein-inactivating units [KIU] loading dose before surgery and 5 10 5 KIU/h duringsurgery, gross dose: 2.5 10 6 KIU, n = 36) and saline solution (control, n = 40) respectively.Perioperative blood samples were collected. Hematologic and hemostatic parameters includingplatelet adhesion rate, D-dimer, and fibrinopeptide-A (FPA) were analyzed. Perioperative CKMBrelease was measured. Volume of blood loss, blood transfusion, and other clinical data wererecorded throughout the perioperative period.Results: Postoperative blood loss was significantly reduced in patients treated with aprotinin(2 hours; median [25th75th]: aprotinin: 90.0 [70.0125.0] ml, control: 145.0 [70.0180.0] ml, P <0.05; 6 hours: aprotinin: 150.0 [100.0220.0] ml, control: 225.0 [200.0347.5.0] ml, P < 0.01;24 hours: aprotinin: 370.0 [220.0510.0] ml, control: 655.0 [500.0920.0] ml, P < 0.01). Thenumber of patients receiving blood transfusion in each group was similar. Levels of D-dimer rosesignificantly after surgery, and were significantly lower in the aprotinin group than in the controls(end of surgery, aprotinin, 0.4 [0.20.5] mg/l versus controls, 1.4 [0.82.3] mg/l; 2 hours, aprotinin, 0.3 [0.20.4] mg/l versus controls, 0.9 [0.51.4] mg/l; 6 hours, aprotinin, 0.3 [0.20.5] mg/lversus controls, 0.6 [0.40.9] mg/l; 24 hours, aprotinin, 0.3 [0.20.4] mg/l versus controls, 0.5[0.40.9] mg/l; ANOVA for repeated measures, P < 0.01). Platelet adhesion rate and FPA levelsremained at baseline levels after the operation in the two groups. Early clinical outcomes weresimilar in the groups....