Influence of aprotinin on early graft thrombosis in patients undergoing myocardial revascularization

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Abstract
One hundred sixty-five patients undergoing primary myocardialrevascularization were prospectively entered into a randomized, double-blind, placebo-controlled study, in a single institution, in order todetermine the influence of high- and low-dose aprotinin application onearly coronary artery bypass graft patency. All patients were operated onby the same team and the three treatment groups were comparable in alldemographic data and surgical variables. Postoperative chest tube drainageand transfusion requirements were significantly reduced in patientsreceiving high or low doses of aprotinin. In all patients vein and internalmammary artery graft patency was assessed by control coronary angiograms 4to 15 days (median 8.2 days) postoperatively. In the high-dose aprotiningroup, 140 of 142 vein grafts and in the low- dose aprotinin group all ofthe 128 vein grafts were patent compared with 138 of 139 in the placebogroup. The difference was not statistically significant (P ≫ 0.05). Allpedicled internal mammary artery grafts were patent in the three treatmentgroups. The prevalence of perioperative myocardial infarction was evaluatedby serial creatine kinase-myocardial band (CK-MB) isoenzyme measurementsand by electrocardiographic recordings. No additional changes that could beattributed to aprotinin were observed. In conclusion, these results suggestthat perioperative myocardial infraction secondary to aprotinin- inducednative coronary artery or conduit thrombosis is not increased by aprotininin patients undergoing primary myocardial revascularization.

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