Applications of Aprotinin in Cardiac Surgery

Abstract

SUMMARYAprotinin has been studied extensively in cardiac surgery and is the only FDA approved pharmacological treatment to reduce blood transfusion in coronary artery bypass grafting (CABG) associated with cardiopulmonary bypass (CPB). Aprotinin has been evaluated in multiple double blind, placebo‐controlled, multicenter studies in cardiac surgery. In US studies, aprotinin has not been associated with an increased risk of post‐CPB myocardial infarction, graft closure, or increased risk of renal dysfunction, and may in fact be associated with a decreased risk of stroke. The mechanism of action is complex, but aprotinin displays antiinflammatory properties due to its complex array of protease inhibition. As with any polypeptide, there is a risk of anaphylaxis that is influenced by prior exposure. Cardiac surgery can be associated with significant bleeding and the need for allogeneic blood products. Although multiple approaches have been reported to reduce bleeding and transfusions, aprotinin represents an important pharmacologic strategy to reduce bleeding.