Con: Aprotinin should not be used in patients undergoing hypothermic circulatory arrest

Abstract

ANTIFIBRINOLYTIC AGENTS reduce blood loss and transfusion during cardiac surgery using cardiopulmonary bypass. 1 Fremes SE Wong BI Lee E et al. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding. Ann Thorac Surg. 1994; 58: 1580-1588 Abstract Full Text PDF PubMed Scopus (202) Google Scholar , 2 Munoz JJ Birkmeyer JO O'Connor GT Dacey LJ Is ϵ-aminocaproic acid as effective as aprotinin in reducing bleeding with cardiac surgery? A meta-analysis. Circulation. 1999; 99: 81-89 Crossref PubMed Scopus (154) Google Scholar This effect has been shown for synthetic agents (ϵ-aminocaproic acid and tranexamic acid) and the naturally occurring aprotinin. Hemostatic superiority of one antifibrinolytic agent over another has not been shown, however. 1 Fremes SE Wong BI Lee E et al. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding. Ann Thorac Surg. 1994; 58: 1580-1588 Abstract Full Text PDF PubMed Scopus (202) Google Scholar , 2 Munoz JJ Birkmeyer JO O'Connor GT Dacey LJ Is ϵ-aminocaproic acid as effective as aprotinin in reducing bleeding with cardiac surgery? A meta-analysis. Circulation. 1999; 99: 81-89 Crossref PubMed Scopus (154) Google Scholar Because procedures involving deep hypothermic circulatory arrest (DHCA) in adults have often been termed “bloodbaths” by clinicians, support for the prophylactic use of aprotinin in such cases has emerged. 3 Smith CR Spanier TB Aprotinin in deep hypothermic circulatory arrest. Ann Thorac Surg. 1999; 68: 278-286 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 4 Royston D A case for aprotinin in patients having deep hypothermic circulatory arrest. J Card Surg. 1997; 12: 214-221 PubMed Google Scholar The bulk of the rather limited existing literature on this subject addresses adults undergoing DHCA for thoracic aortic procedures, so this discussion is limited to that clinical context. The discussion addresses two questions: 1.Is aprotinin safe for DHCA? 2.Is aprotinin desirable for DHCA?