Aprotinin inhibits fibrinolysis, improves platelet adhesionand reduces blood lossResults of a double-blind randomized clinical trial

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Abstract
The present recommendation is that aprotinin should be started beforecardiac surgery, but as bleeding is only a problem in a minority, mostpatients are treated unnecessarily. In a prospective, randomised,double-blind trial we have studied the use of aprotinin, given only to theminority of patients who bled significantly post-operatively and who hadnot received prophylactic aprotinin. Sixty patients, who bled in excess of400 ml in the first 3 h post-operatively were randomised to receive eitheraprotinin (2 x 10(6) KIU loading dose followed by an infusion of 0.5 x10(6) KIU/h for 4 h) or placebo, in addition to conventional treatment. Thedemographic characteristics and the surgical procedures performed weresimilar in the two groups. Haematological variables were measured (A)before and (B) at the end of the infusion. Three patients were re-exploredfor excessive bleeding in each group and one patient died in each group.The patients in the aprotinin group bled significantly less and had higherhaemoglobin levels on discharge than the patients in the placebo group. Thetissue plasminogen activator antigen decreased and the fibrinogen levelincreased in the aprotinin group. In addition, aprotinin increased thenumber of surface GPIb platelet receptors as estimated by flow cytometry(36% versus 5%, P < 0.01) and maintained the platelet von WillebrandFactor activity (vWF). There was no significant difference in D-dimers,fibrin(ogen) degradation products, plasma vWF activity and antigen,platelet vWF antigen, platelet aggregation (to collagen, arachidonic acid,platelet activating factor and ristocetin), platelet count or transfusionof blood products between the two groups.(ABSTRACT TRUNCATED AT 250WORDS)

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