Efficacy of minimal dose aprotinin in open heart procedures.

ABSTRACT

In a randomized double blind study, 30 patients posted for CABG surgery were assigned to 3 groups of 10 each. Group A received 140 mg (1,000,000 KIU) of aprotinin after induction of anaesthesia but before sternotomy, an equal amount in the pump prime and a maintenance dose of 70 mg/hr throughout cardiopulmonary bypass (standard dose). Group B received placebo after induction of anaesthesia, 70 mg (500,000 KIU) aprotinin in the pump prime with a placebo as a maintenance dose (minimal dose). Group C received a placebo after induction of anaesthesia, in the prime and as a maintenance dose (control group). The mean chest closure times were insignificantly lower in the aprotinin groups; 35.83 +/- 13.93 mins in group A and 37.5 +/- 10 mins in group B as against 57.25 +/- 26.54 mins in group C. Post-operative haemoglobin loss was significantly lower (P<0.01) in aprotinin groups, 5.42 +/- 1.6 gm in group A and 6.28 +/- 2.49 gms in group B, as against 39.77 +/- 27.51 gm in group C. Whole blood transfusion requirement was also significantly reduced from 4.12 +/- 1.79 units in the control group to 2.5 +/- 0.75 units in group A (p < 0.05) and 2 +/- 1.3 units (p<0.01) in group B. We conclude that a minimal dose of aprotinin 70 mg (500,000 KIU) is effective in reducing postoperative blood loss, blood transfusion requirement and is economical.