, Volume 31, Issue 7, pp 557-560
Date: 20 Nov 2012

Perioperative Safety of Aprotinin in Coronary Artery Bypass Graft Surgery

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The safety profile of perioperative aprotinin in coronary artery bypass grafting (CABG) has been intensely scrutinized since the publication in 2006 of the controversial article by Mangano and colleagues[1] in which they evaluated the outcome risk associated with aprotinin for CABG. In this landmark study, propensity-adjusted multivariate analysis demonstrated that the adverse outcomes after CABG were not only significantly associated with aprotinin exposure but also that they were dependent on the aprotinin dose. Even though low-dose aprotinin was associated with a lower outcome risk than high-dose aprotinin, it was still a significant perioperative risk factor for renal dysfunction (p > 0.001) and composite adverse outcome (p = 0.003).[1]

Since this paper was published in January 2006, there has been a flood of discussion about the perioperative safety of aprotinin.[2] Recent high-quality meta-analysis has demonstrated that low-dose aprotinin reduces blood loss and transfusion, but is