The Risk Associated with Aprotinin in Cardiac Surgery
The antifibrinolytic agent aprotinin is often used to control blood loss in patients undergoing cardiac surgery. This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage. In patients undergoing cardiac surgery, aprotinin should be repl...
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| Veröffentlicht in: | The New England journal of medicine 2006-01, Vol.354 (4), p.353-365 |
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| creator | Mangano, Dennis T Tudor, Iulia C Dietzel, Cynthia |
| description | The antifibrinolytic agent aprotinin is often used to control blood loss in patients undergoing cardiac surgery. This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage. In patients undergoing cardiac surgery, aprotinin should be replaced by aminocaproic acid or tranexamic acid.
Aprotinin is often used to control blood loss in patients undergoing cardiac surgery. This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage.
The mainstay of medical therapy for patients with an acute coronary syndrome — when accompanied by myocardial infarction with ST-segment elevation — includes fibrinolytic and antiplatelet agents to mitigate thrombosis-related events.
1
However, if surgical therapy (coronary-artery surgery) is elected, fibrinolytic agents are not used before, during, or after surgery because of concerns regarding excessive bleeding. In fact, these bleeding-related concerns have given rise to the testing, regulatory approval, and widespread use of two classes of agents, both proven to mitigate bleeding: the lysine analogues (aminocaproic acid and tranexamic acid) and the serine protease inhibitors (aprotinin). Consequently, the majority of patients . . . |
| doi_str_mv | 10.1056/NEJMoa051379 |
| format | Article |
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Aprotinin is often used to control blood loss in patients undergoing cardiac surgery. This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage.
The mainstay of medical therapy for patients with an acute coronary syndrome — when accompanied by myocardial infarction with ST-segment elevation — includes fibrinolytic and antiplatelet agents to mitigate thrombosis-related events.
1
However, if surgical therapy (coronary-artery surgery) is elected, fibrinolytic agents are not used before, during, or after surgery because of concerns regarding excessive bleeding. In fact, these bleeding-related concerns have given rise to the testing, regulatory approval, and widespread use of two classes of agents, both proven to mitigate bleeding: the lysine analogues (aminocaproic acid and tranexamic acid) and the serine protease inhibitors (aprotinin). Consequently, the majority of patients . . .</description><identifier>ISSN: 0028-4793</identifier><identifier>EISSN: 1533-4406</identifier><identifier>DOI: 10.1056/NEJMoa051379</identifier><identifier>PMID: 16436767</identifier><identifier>CODEN: NEJMAG</identifier><language>eng</language><publisher>Boston, MA: Massachusetts Medical Society</publisher><subject>Acids ; Acute coronary syndromes ; Adult ; Aminocaproates - adverse effects ; Aminocaproates - therapeutic use ; Antifibrinolytic Agents - adverse effects ; Antifibrinolytic Agents - therapeutic use ; Aprotinin - adverse effects ; Aprotinin - therapeutic use ; Biological and medical sciences ; Blood Loss, Surgical - prevention & control ; Cardiac Surgical Procedures ; Cardiovascular Diseases - chemically induced ; Cardiovascular Diseases - epidemiology ; Cerebrovascular Disorders - chemically induced ; Cerebrovascular Disorders - epidemiology ; Coma ; Drug therapy ; Female ; General aspects ; Heart attacks ; Humans ; Logistic Models ; Male ; Medical sciences ; Multivariate Analysis ; Myocardial Infarction - chemically induced ; Myocardial Infarction - epidemiology ; Patients ; Postoperative Hemorrhage - prevention & control ; Prospective Studies ; Regulatory approval ; Renal Insufficiency - chemically induced ; Renal Insufficiency - epidemiology ; Serine Proteinase Inhibitors - adverse effects ; Serine Proteinase Inhibitors - therapeutic use ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Tranexamic Acid - adverse effects ; Tranexamic Acid - therapeutic use ; Veins & arteries</subject><ispartof>The New England journal of medicine, 2006-01, Vol.354 (4), p.353-365</ispartof><rights>Copyright © 2006 Massachusetts Medical Society. All rights reserved.</rights><rights>2006 INIST-CNRS</rights><rights>Copyright 2006 Massachusetts Medical Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c543t-fa2fc541fede59ba5e194fc241e4f65ab7993d9fa8c563c8bcca5fb3247677a83</citedby><cites>FETCH-LOGICAL-c543t-fa2fc541fede59ba5e194fc241e4f65ab7993d9fa8c563c8bcca5fb3247677a83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.nejm.org/doi/pdf/10.1056/NEJMoa051379$$EPDF$$P50$$Gmms$$H</linktopdf><linktohtml>$$Uhttps://www.nejm.org/doi/full/10.1056/NEJMoa051379$$EHTML$$P50$$Gmms$$H</linktohtml><link.rule.ids>314,776,780,2746,2747,26080,27901,27902,52357,54039</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17449201$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16436767$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mangano, Dennis T</creatorcontrib><creatorcontrib>Tudor, Iulia C</creatorcontrib><creatorcontrib>Dietzel, Cynthia</creatorcontrib><creatorcontrib>Ischemia Research and Education Foundation</creatorcontrib><creatorcontrib>Multicenter Study of Perioperative Ischemia Research Group</creatorcontrib><title>The Risk Associated with Aprotinin in Cardiac Surgery</title><title>The New England journal of medicine</title><addtitle>N Engl J Med</addtitle><description>The antifibrinolytic agent aprotinin is often used to control blood loss in patients undergoing cardiac surgery. This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage. In patients undergoing cardiac surgery, aprotinin should be replaced by aminocaproic acid or tranexamic acid.
Aprotinin is often used to control blood loss in patients undergoing cardiac surgery. This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage.
The mainstay of medical therapy for patients with an acute coronary syndrome — when accompanied by myocardial infarction with ST-segment elevation — includes fibrinolytic and antiplatelet agents to mitigate thrombosis-related events.
1
However, if surgical therapy (coronary-artery surgery) is elected, fibrinolytic agents are not used before, during, or after surgery because of concerns regarding excessive bleeding. In fact, these bleeding-related concerns have given rise to the testing, regulatory approval, and widespread use of two classes of agents, both proven to mitigate bleeding: the lysine analogues (aminocaproic acid and tranexamic acid) and the serine protease inhibitors (aprotinin). Consequently, the majority of patients . . .</description><subject>Acids</subject><subject>Acute coronary syndromes</subject><subject>Adult</subject><subject>Aminocaproates - adverse effects</subject><subject>Aminocaproates - therapeutic use</subject><subject>Antifibrinolytic Agents - adverse effects</subject><subject>Antifibrinolytic Agents - therapeutic use</subject><subject>Aprotinin - adverse effects</subject><subject>Aprotinin - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Blood Loss, Surgical - prevention & control</subject><subject>Cardiac Surgical Procedures</subject><subject>Cardiovascular Diseases - chemically induced</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cerebrovascular Disorders - chemically induced</subject><subject>Cerebrovascular Disorders - epidemiology</subject><subject>Coma</subject><subject>Drug therapy</subject><subject>Female</subject><subject>General aspects</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Multivariate Analysis</subject><subject>Myocardial Infarction - chemically induced</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Patients</subject><subject>Postoperative Hemorrhage - prevention & control</subject><subject>Prospective Studies</subject><subject>Regulatory approval</subject><subject>Renal Insufficiency - chemically induced</subject><subject>Renal Insufficiency - epidemiology</subject><subject>Serine Proteinase Inhibitors - adverse effects</subject><subject>Serine Proteinase Inhibitors - therapeutic use</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Tranexamic Acid - adverse effects</subject><subject>Tranexamic Acid - therapeutic use</subject><subject>Veins & arteries</subject><issn>0028-4793</issn><issn>1533-4406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNpt0M9LwzAUB_AgipvTm2cpojerSfOjzXGM-YupoPNcXtPEZa7tTFpk_72RFebBR-Dl8OG9xxehU4KvCebi5nn6-NQA5oSmcg8NCac0ZgyLfTTEOMlilko6QEfeL3EowuQhGhDBqEhFOkR8vtDRq_Wf0dj7RllodRl923YRjdeuaW1t6yi8CbjSgoreOveh3eYYHRhYeX3S9xF6v53OJ_fx7OXuYTKexYoz2sYGEhN-xOhSc1kA10QyoxJGNDOCQ5FKSUtpIFNcUJUVSgE3BU1YuC2FjI7Q-XZuuOWr077Nl03n6rAyTxIqaSapCOhqi5RrvHfa5GtnK3CbnOD8N6L8b0SBn_Uzu6LS5Q73mQRw2QPwClbGQa2s37mUMZlgEtzF1lWVz2u9rP7f9wPjmXiI</recordid><startdate>20060126</startdate><enddate>20060126</enddate><creator>Mangano, Dennis T</creator><creator>Tudor, Iulia C</creator><creator>Dietzel, Cynthia</creator><general>Massachusetts Medical Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K0Y</scope><scope>LK8</scope><scope>M0R</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope></search><sort><creationdate>20060126</creationdate><title>The Risk Associated with Aprotinin in Cardiac Surgery</title><author>Mangano, Dennis T ; Tudor, Iulia C ; Dietzel, Cynthia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c543t-fa2fc541fede59ba5e194fc241e4f65ab7993d9fa8c563c8bcca5fb3247677a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Acids</topic><topic>Acute coronary syndromes</topic><topic>Adult</topic><topic>Aminocaproates - adverse effects</topic><topic>Aminocaproates - therapeutic use</topic><topic>Antifibrinolytic Agents - adverse effects</topic><topic>Antifibrinolytic Agents - therapeutic use</topic><topic>Aprotinin - adverse effects</topic><topic>Aprotinin - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Blood Loss, Surgical - prevention & control</topic><topic>Cardiac Surgical Procedures</topic><topic>Cardiovascular Diseases - chemically induced</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cerebrovascular Disorders - chemically induced</topic><topic>Cerebrovascular Disorders - epidemiology</topic><topic>Coma</topic><topic>Drug therapy</topic><topic>Female</topic><topic>General aspects</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Multivariate Analysis</topic><topic>Myocardial Infarction - chemically induced</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Patients</topic><topic>Postoperative Hemorrhage - prevention & control</topic><topic>Prospective Studies</topic><topic>Regulatory approval</topic><topic>Renal Insufficiency - chemically induced</topic><topic>Renal Insufficiency - epidemiology</topic><topic>Serine Proteinase Inhibitors - adverse effects</topic><topic>Serine Proteinase Inhibitors - therapeutic use</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. 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This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage. In patients undergoing cardiac surgery, aprotinin should be replaced by aminocaproic acid or tranexamic acid.
Aprotinin is often used to control blood loss in patients undergoing cardiac surgery. This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage.
The mainstay of medical therapy for patients with an acute coronary syndrome — when accompanied by myocardial infarction with ST-segment elevation — includes fibrinolytic and antiplatelet agents to mitigate thrombosis-related events.
1
However, if surgical therapy (coronary-artery surgery) is elected, fibrinolytic agents are not used before, during, or after surgery because of concerns regarding excessive bleeding. In fact, these bleeding-related concerns have given rise to the testing, regulatory approval, and widespread use of two classes of agents, both proven to mitigate bleeding: the lysine analogues (aminocaproic acid and tranexamic acid) and the serine protease inhibitors (aprotinin). Consequently, the majority of patients . . .</abstract><cop>Boston, MA</cop><pub>Massachusetts Medical Society</pub><pmid>16436767</pmid><doi>10.1056/NEJMoa051379</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The New England journal of medicine, 2006-01, Vol.354 (4), p.353-365 |
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| subjects | Acids Acute coronary syndromes Adult Aminocaproates - adverse effects Aminocaproates - therapeutic use Antifibrinolytic Agents - adverse effects Antifibrinolytic Agents - therapeutic use Aprotinin - adverse effects Aprotinin - therapeutic use Biological and medical sciences Blood Loss, Surgical - prevention & control Cardiac Surgical Procedures Cardiovascular Diseases - chemically induced Cardiovascular Diseases - epidemiology Cerebrovascular Disorders - chemically induced Cerebrovascular Disorders - epidemiology Coma Drug therapy Female General aspects Heart attacks Humans Logistic Models Male Medical sciences Multivariate Analysis Myocardial Infarction - chemically induced Myocardial Infarction - epidemiology Patients Postoperative Hemorrhage - prevention & control Prospective Studies Regulatory approval Renal Insufficiency - chemically induced Renal Insufficiency - epidemiology Serine Proteinase Inhibitors - adverse effects Serine Proteinase Inhibitors - therapeutic use Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Tranexamic Acid - adverse effects Tranexamic Acid - therapeutic use Veins & arteries |
| title | The Risk Associated with Aprotinin in Cardiac Surgery |
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