Aprotinin in Cardiac Surgery

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Abstract
Although potent and effective drugs may have undesirable side effects in some patients, we believe that the study by Mangano et al. (Jan. 26 issue)1 overemphasizes the risk of aprotinin for the prevention of bleeding during cardiac surgery without a demonstration of its substantial benefits. This overemphasis may have occurred because of a flawed study design, imprecision in the definition of variables, selection bias during development of the study model, and a lack of proper weighting of evidence from the literature.