Reduktion des postoperativen Blutverlustes und des Fremdblutverbrauches in der Herzchirurgie mit Aprotinin: Erfahrungen mit unterschiedlicher Dosierung. [Reduction of postoperative blood loss and donor blood use in heart surgery with aprotinin: experience with various dosages]

Détails

ID Serval
serval:BIB_1B311E196594
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Reduktion des postoperativen Blutverlustes und des Fremdblutverbrauches in der Herzchirurgie mit Aprotinin: Erfahrungen mit unterschiedlicher Dosierung. [Reduction of postoperative blood loss and donor blood use in heart surgery with aprotinin: experience with various dosages]
Périodique
Helvetica Chirurgica Acta
Auteur(s)
Carrel  T., Bauer  E., Garcia  E., von Segesser  L., Niederhauser  U., Schonbeck  M., Laske  A., Turina  M.
ISSN
0018-0181
Statut éditorial
Publié
Date de publication
09/1991
Volume
58
Numéro
3
Pages
365-78
Notes
Clinical Trial
Comparative Study
English Abstract
Journal Article
Randomized Controlled Trial --- Old month value: Sep
Résumé
The effect of high dose aprotinin was evaluated in a prospective study on 100 patients undergoing cardiopulmonary bypass. Special attention was made on postoperative blood loss and transfusions of bank blood postoperatively. In the first part of the study, after induction of anesthesia, a loading dose of 2,000,000 kallikrein-inhibiting-unit (KIU) = 280 mg aprotinin was given intravenously over a 30-min period. Immediately afterward, a continuous infusion of 500,000 KIU/h was started and maintained until skin closure. Another 2,000,000 KIU was added to the priming volume of the heart-lung machine. A control group of 50 patients was randomized with similar indication for surgery and past cardiac history. The total loss from the thoracic drains was significantly reduced in the aprotinin group as compared with the loss in the control group (490 +/- 265 ml versus 1045 +/- 380 ml). In a separate group of risk patients (redo-operations, infective endocarditis) the total blood loss was even more significant reduced in the aprotinin group (690 +/- 195 ml versus 1585 +/- 290 ml). Patients of the aprotinin group received markedly less bank blood postoperatively (350 +/- 100 ml versus 900 +/- 240 ml without aprotinin). Part II of the study (36 patients) consisted of lower dosage (2,000,000 KIU intravenously during induction of anesthesia only or 2,000,000 KIU in the priming volume of the heart-lung machine only). Patients who received aprotinin in the heart-lung machine only showed no significant difference regarding blood loss and blood requirement to patients with high dose aprotinin. It appears possible that aprotinin reduces the activation of the coagulation during cardiopulmonary bypass and preserves platelet function without affecting platelet consumption during the extracorporeal circulation. The results of our study demonstrate that high dose aprotinin markedly reduces blood loss as well as homologous blood requirement in the early postoperative course of cardiosurgical patients. Similar effects due to reduced aprotinin dose have been observed in patients receiving aprotinin in the extracorporeal circulation only.
Mots-clé
Aged Aprotinin/*administration & dosage Blood Loss, Surgical/*prevention & control *Blood Transfusion Cardiopulmonary Bypass *Coronary Artery Bypass Dose-Response Relationship, Drug Female Humans Male Middle Aged Prospective Studies
Pubmed
Web of science
Création de la notice
14/02/2008 14:16
Dernière modification de la notice
20/08/2019 12:51
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