Letter to the Editors-in-ChiefAprotinin, but not tranexamic acid, is associated with increased pulmonary microvascular fibrin deposition after cardiac surgery
Section snippets
Materials and methods
A case control study was undertaken. Allocation to the anti-fibrinolytic regimen was not randomised. Patients undergoing elective cardiac surgery with cardiopulmonary (CPB) were eligable. Patients were excluded if they were having re-do cardiac surgery, plasma creatinine greater than 250 μmol/L or age greater than 85. Cases: Six patients were not administered an anti-fibrinolytic agent, 4 patients were administered tranexamic acid and 4 patients aprotinin. In these patients an open wedge biopsy
Results
The groups were similar with respect to baseline and operative characteristics (Table 1). Post-operative outcomes including duration of mechanical ventilation, intensive care and hospital stays were also similar.
The extent of pulmonary microvascular fibrin deposition following CPB was higher in the aprotinin group compared with pre-CPB bypass levels (control group), 42 (33–57) vs 0.6 (0.1-9.4) deposits per mm2 of alveolar tissue, p < 0.05. There was, however, no difference in the extent of
Discussion
We found aprotinin, but not tranexamic acid, was associated with an increased number of pulmonary microvascular fibrin deposits following cardiac surgery.
Aprotinin is a unique anti-fibrinolytic, because unlike lysine analogues, it also promotes coagulation activation through inhibition of the endogenous anti-coagulant activated protein C. Aprotinin competitively binds to the active site of activated protein C and inhibits it in a dose dependent manner [4], [5], [6], [7]. Aprotinin may also
Competing interests
The authors declare that they have no competing interests.
Acknowledgements
We would like to acknowledge and thank the patients who volunteered to participate in this study.
Funding source: Supported by a grant from the St.Vincent's Hospital Research Endowment Fund.
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2024, Journal of Cardiothoracic and Vascular AnesthesiaDrugs that affect blood coagulation, fibrinolysis, and hemostasis
2014, Side Effects of Drugs AnnualCitation Excerpt :The authors proposed that the structural similarity of ɛ-aminocaproic acid to lysine and arginine suggested a possible mechanism, by which cationic amino acids promote the extracellular transport of potassium in an electroneutral process. Respiratory In a case-control study in patients who underwent cardiopulmonary bypass and were given tranexamic acid (n = 4), aprotinin (n = 4), or no antifibrinolytic drug (n = 6), those who were given aprotinin had more fibrin deposition in the pulmonary vasculature in lung biopsies [103c]. Urinary tract In a retrospective comparison of aprotinin and ɛ-aminocaproic acid in children undergoing cardiac surgery there was a higher risk of acute kidney damage with aprotinin [104c], as there is in adults [SEDA-33, 724].
A trial of nebulised heparin to limit lung injury following cardiac surgery
2016, Anaesthesia and Intensive Care