Effect of low-dose Aprotinin on Postoperative Bleeding and Renal Function after Cardiopulmonary Bypass

Park, Chul Hyun; Hyun, Sung Yeol; Lee, Hun Jae; Park, Kook Yang; Kim, Ju E; Lim, Chang Young

Abstract

High-dose aprotinin (Hammersmith regimen) has been widely used for years to control postoperative bleeding and reduce blood consumption in cardiac surgery but had known to cause some side-effects and had disadvantage in cost-effectiveness. The prospective controlled study of 33 patients undergoing cardiopulmonary bypass was performed to evaluate the efficacy for reducing postoperative bleeding and unfavorable effects of low-dose aprotinin. The level of hemoglobin and platelet in the blood and the amount of postoperative bleeding were assessed preoperatively, and postoperatively for the study of hemostatic function. The level of BUN and serum creatinine in the blood, levels of urine creatinine, total protein, albumin, alpha-1-microglobulin and creatinine clearance were assessed before and after the operation for the study of renal function. The aprotinin group had a significant reduction in chest tube drainage; 243+/- 123 ml versus 406+/-303 ml (P=0.037) during 6 hours immediate-postoperatively, 494+/-358 ml versus 869+/-570 ml (P=0.045) during 24 hours postoperatively. The ratio of alpha-1-microglobulin/creatinine and microalbumin/creatinine in the urine were slightly increased in the aprotinin group postoperatively in comparison with the control group but there were no statistically significant difference (55+/-23 versus 24+/-10 in the alpha-1-microglobulin/creatinine, 56+/-19 versus 38+/-25 in the microalbumin/creatinine at post- operative 3rd day). There were no significant difference between two groups in other parameters of renal function, too. This study showed that low-dose aprotinin is an effective means of reducing postoperative bleeding without inducing significant renal dysfunction.