Abstract
Cardiac surgery is associated with a systemic inflammatory response and systemic coagulopathy, which can result in significant organ dysfunction and bleeding. Aprotinin, a serine protease inhibitor, can limit systemic inflammation, and has been associated with myocardial, pulmonary and cerebral protection in addition to its proven haemostatic efficacy. Data are currently conflicting regarding the haemostatic efficacy of aprotinin relative to alternative agents including tranexamic acid. Recent studies have demonstrated aprotinin usage is associated with increased rates of thrombotic and renal complications, but these findings are at odds with the majority of studies relating to aprotinin safety to date. The lack of adequately powered, randomised studies evaluating aprotinin and alternative agents limits drawing conclusions about the complete use or disuse of aprotinin presently and requires individualised patient selection based on bleeding risk and co-morbidities for its usage.
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Dr Sodha and Dr Boodhwani have no conflicts of interest that are directly relevant to the content of this article. Dr Sellke is a member of the Speaker’s Bureau for Bayer Corporation. No sources of funding were used to assist in the preparation of this manuscript.
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Sodha, N.R., Boodhwani, M. & Sellke, F.W. Is There Still a Role for Aprotinin in Cardiac Surgery?. Drug-Safety 30, 731–740 (2007). https://doi.org/10.2165/00002018-200730090-00001
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DOI: https://doi.org/10.2165/00002018-200730090-00001