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Eur J Cardiothorac Surg 2002;22:545-551
© 2002 Elsevier Science NL

Aprotinin reduces blood loss in off-pump coronary artery bypass (OPCAB) surgery

Department of Cardiovascular Surgery, University Hospital Berne (Inselspital), Freiburgstrasse, 3010 Bern, Switzerland

Received 10 March 2002; received in revised form 11 July 2002; accepted 19 July 2002.

* Corresponding author. Tel.: +41-31-632-2375; fax: +41-31-632-4443
e-mail: lars.englberger{at}insel.ch

Objective: Effects of aprotinin in off-pump coronary artery bypass (OPCAB) surgery have not yet been described. This study analyses hemostasiologic changes and potential benefit in OPCAB patients treated with aprotinin. Methods: In a prospective, double-blind, randomized study 47 patients undergoing OPCAB surgery were investigated. Patients received either aprotinin (2x10⁶ KIU loading dose and 0.5x10⁶ KIU/h during surgery, n=22) or saline solution (control, n=25). Activated clotting time was adjusted to a target of 250 s intraoperatively. Blood samples were taken up to 18 h postoperatively: complete hematologic and hemostasiologic parameters including fibrinopeptide A (FPA) and D-dimer in a subgroup of 31 patients were analyzed. Blood loss, blood transfusion and other clinical data were collected. Results: Both groups showed comparable demographic and intraoperative variables. Forty-one (87%) patients of the whole study group received aspirin within 7 days prior to surgery. Number of grafts per patient were comparable (2.9±1.0 [mean±SD] in the aprotinin group and 2.8±1.2 in control, P=0.83). Blood loss during the first 18 h in intensive care unit was significantly reduced in patients treated with aprotinin (median [25th–75th percentiles]: 500 [395–755] ml vs. 930 [800–1170] ml, P<0.001). Postoperatively only two patients (10%) in the aprotinin group received packed red blood cells, whereas eight (35%) in the control group (P=0.07). Perioperatively FPA levels reflecting thrombin generation were elevated in both groups. The increase in D-dimer levels after surgery was significantly inhibited in the aprotinin group (P<0.001). Early clinical outcome was similar in both groups. Conclusions: Aprotinin significantly reduces blood loss in patients undergoing OPCAB surgery. Inhibition of enhanced fibrinolysis can be observed. FPA generation during and after OPCAB surgery seems not to be influenced by aprotinin.

Key Words: Aprotinin • Off-pump coronary artery bypass • Fibrinopeptide A • D-dimer

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