Plasma Aprotinin Concentrations During Cardiac Surgery: Full- Versus Half-Dose Regimens

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Abstract
Aprotinin is an effective but expensive drug used dur- ing cardiac surgery to reduce blood loss and transfu- sion requirements. Currently, aprotinin is adminis- tered to adults according to a fixed protocol regardless of the patient's weight. The purpose of this study was to determine aprotinin levels in patients receiving full- and half-dose aprotinin regimens by a simple func- tional aprotinin assay and to design a more individual- ized aprotinin dosage regimen for cardiac surgical patients. The mean plasma aprotinin concentration peaked 5 min after the initiation of cardiopulmonary bypass (full 401 6 92 KIU/mL, half 226 6 56 KIU/mL). The mean plasma aprotinin concentration after 60 min on cardiopulmonary bypass was less (full 236 6 81 KIU/mL, half 160 6 63 KIU/mL). There was large variation in the aprotinin concentration among pa- tients. A statistically significant correlation was found between aprotinin concentration and patient weight (r2 5 0.67, P , 0.05). (Anesth Analg 2000;91:257-64)