Aprotinin in Aortocoronary Bypass Surgery: Increased Risk of Vein-Graft Occlusion and Myocardial Infarction? Supportive Evidence from a Retrospective Study

J van der Meer; H L Hillege; C A P L Ascoop; P H J M Dunselman; B J M Mulder; G V A van Ormmen; M Pfisterer; W H van Gilst; K I Lie; For the CABADAS Research Group of the Interuniversity Cardiology institute of the Netherlands

doi:10.1055/s-0038-1650311

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1996; 75(01): 001-003
DOI: 10.1055/s-0038-1650311

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Schattauer GmbH Stuttgart

Aprotinin in Aortocoronary Bypass Surgery: Increased Risk of Vein-Graft Occlusion and Myocardial Infarction? Supportive Evidence from a Retrospective Study

J van der Meer

¹The University Hospital, Groningen, The Netherland

,

H L Hillege

¹The University Hospital, Groningen, The Netherland

,

C A P L Ascoop

²The St. Antonius Hospital, Nieuwegein, The Netherland

,

P H J M Dunselman

³The Ignatius Hospital, Breda, The Netherland

,

B J M Mulder

⁴The Academic Medical Centre, Amsterdam, The Netherland

,

G V A van Ormmen

⁵The University Hospital, Maastricht, The Netherlands

,

M Pfisterer

⁶The University Hospital, Basel, Switzerland

,

W H van Gilst

¹The University Hospital, Groningen, The Netherland

,

K I Lie

¹The University Hospital, Groningen, The Netherland

,

For the CABADAS Research Group of the Interuniversity Cardiology institute of the Netherlands

› Author Affiliations

Abstract

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Summary

To assess the thrombotic risk of aprotinin in aortocoronary bypass surgery, we retrospectively analyzed the results of a trial, originally designed to compare the effects of one-year treatment with various antithrombotic drugs in the prevention of vein-graft occlusion. Graft patency at one year was assessed by angiography. Myocardial infarction, thromboembolism, major bleeding, and death were clinical endpoints. Of 948 randomized patients, 42 received aprotinin, all enrolled by one of the participating centres. Occlusion rates of distal anastomoses were 20.5% in the aprotinin group and 12.7% in the non-aprotinin group (p = 0.091). The proportions of patients with occluded grafts were 44.1% versus 26.3% (p = 0.029). Perioperative myocardial infarction occurred in 14.3% and 7.0%, respectively (p = 0.12). Mean postoperative blood loss was 451 ml in the aprotinin group compared with 1039 ml in the non-aprotinin group (p <0.0001). Mean transfusion requirements were 1.1 U versus 2.1 U of red blood cells (p = 0.004).

Aprotinin decreases blood loss and transfusion requirement. Our data suggest that this benefit may be associated with a reduction of graft patency and an increased risk of myocardial infarction.

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References

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