The use of micro-dose aprotinin with continuous infusion in coronary artery bypass surgery.

Background: To evaluate the efficacy of aprotinin at a dose far less than standard.

Experimental Design: Retrospective, case-control study.

Setting: community-based, teaching hospital

Patients: one hundred one patients undergoing primary, non-emergent, coronary artery bypass during two, six-month periods were studied.

Interventions: during the first period aprotinin was not administered, and these patients served as controls (n = 52). During the second period all patients received aprotinin via a micro-dose regimen (n = 49).

Measures: postoperative bleeding and blood product usage served as determinants of efficacy.

Results: A significant difference existed in postoperative bleeding with the mean thoracic drain outputs being reduced in the aprotinin group both at 6 hours (p = 0.0003) and in total (p = 0.0004). This was further supported by significantly higher hematocrits (p = 0.03) on the first postoperative day in patients receiving aprotinin. Likewise, there was a significant reduction in total blood product exposures (p = 0.04) and platelet usage (p = 0.02) in the aprotinin group with a tendency towards decreased red cell usage. Further, when all patients with a hematocrit < or =30% prior to bypass were excluded, the significant reduction in total blood product exposures persisted (p = 0.04), and there was a significant reduction in red cell usage (p = 0.04) with a trend towards decreased platelet usage (p = 0.06) in the aprotinin group.

Conclusions: Micro-dose aprotinin significantly reduces postoperative bleeding and blood product usage in primary, non-emergent, CABG patients.