Use of aprotinin in repeat myocardial revascularization: Cleveland Clinic experience

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Abstract
Preliminary findings of a prospective, randomized, double-blind study of aprotinin in patients undergoing repeat myocardial revascularization procedures are presented. Use of high- or low-dose aprotinin led to signfiicant (p < 0.001) reductions in postoperative chest tube drainage compared with placebo (720 ± 753 ml, 866 ± 1636 ml, and 1121 ± 683 ml, respectively). Aprotinin also yielded significant reductions in transfusion requirements (2.1 ± 4.2 units, 4.8 ± 11.8 units, and 4.1 ± 6.2 units). These reductions were similar in a subgroup of patients who received aspirin preoperatively. In both aprotinin groups, there was a non-significant trend toward increased risk of Q-wave myocardial infarction. In six of 12 vein grafts studied at post-mortem examination from aprotinin-treated patients, acute vein graft thrombosis was found. This was not seen in any of five grafts from placebo-treated patients. In conclusion, aprotinin significantly reduces bleeding and transfusion requirements in patients undergoing repeat myocardial revascularization. The non-significantly increased risk of graft thrombosis requires further study.