Prohemostatic therapy: the rise and fall of aprotinin.

Aprotinin has been used clinically to enhance hemostasis for decades and was approved in the United States by the Food and Drug Administration in 1993 to reduce the transfusion requirement during coronary artery bypass surgery. Marketing of aprotinin ceased recently when observational studies and a randomized clinical trial reported increased cardiovascular toxicity in patients receiving this drug. The importance of prohemostatic therapy is reviewed in light of new information on long-term deleterious effects of blood transfusion, including increased risk of cardiovascular disease, malignancy, and infection possibly attributable to delivery of a load of red cell-derived redox-active iron.

Agranulocytosis associated with lamotrigine in a patient with low-grade glioma.

Purpose: To report agranulocytosis associated with lamotrigine (LTG) in a patient with a brain tumor.

Methods: A 59-year-old woman with a low-grade glioma and difficult-to-control partial seizures developed agranulocytosis between 9 and 14 weeks after starting LTG. The patient underwent chemotherapy 2 years previously.