The Use of Aprotinin in Heart Transplantation

pp 447-451

Abstract

Background

As it is known, in presence of none endothelial surfaces, blood activates mechanisms which at the same time stimulates the coagulation and fibrinolysis path. This occurs during extra corporeal circulation where, the administrated heparin cannot completely inhibit this effects. Aprotinin is a seric and plasmatic protease inhibitor, like plasmin and kalikrein. It plays an active part in coagulation mechanism. On the other side, heart transplant surgery has high risk factors of post-operative blood loss, like: oral anticoagulation administrated to waiting list patients; hepatic congestion for right ventricular failure; high frequency of previous open heart surgery and the long extension sutures to be done.

Method

We analized a population of 23 heart transplanted patients; 12 received 2,500,00IU aprotinin (AP group), and 11 without this drug (C group).

Results

The AP group showed less blood loss, as well as less homologous blood requirements (in both p <0.05). In this group reoperation for blood loss was not necessary, but in the C group 2 patients were re-explored. No significant differences were found in coagulation controls. No drug adverse effects were found.

Conclusions

Aprotinin is effective in reducing bleeding and transfusion requirements, without increasing the incidence of adverse effects.