1 / 10

Aprotinin

Aprotinin. Emily Sarver. Background. 600,000 people in US undergo heart surgery per year 30% require blood transfusion Blood transfusion is a strong predictor of mortality 77% increased risk of death Conservation of blood is important… Shortage of donor blood Risk (infection, death) Cost.

kyrie
Download Presentation

Aprotinin

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Aprotinin Emily Sarver

  2. Background • 600,000 people in US undergo heart surgery per year • 30% require blood transfusion • Blood transfusion is a strong predictor of mortality • 77% increased risk of death • Conservation of blood is important… • Shortage of donor blood • Risk (infection, death) • Cost

  3. Background • CPB circulates and oxygenates the blood • CPB increases the risk of transfusion • Coagulopathy • Hemodilution • Entire blood mass is anticoagulated + exposed to extracorporeal materials • This interface results in… • Activated coagulation proteins • Decreased platelet count and function • Activation of systemic inflammatory response • Basically – hemostasis is transformed into chaos

  4. Aprotinin (Trasylol) • Antifibrinolytic used to decrease bleeding • FDA approved since 1993 • Slows down fibrinolysis • Decreases need for blood transfusions during surgery • Decreases end-organ damage due to blood loss

  5. Mechanism of Action • Strongly inhibits plasmin (inhibits fibrinolysis) • Blocks conversion of kininogen to bradykinin (inflammatory mediator) • Inhibits activation of C1 of the complement system • Preserves the adhesive glycoproteins in platelets • Increases resistance to damage • Allows platelet adhesion to endothelium • Prevents expression of pro-inflammatory glycoproteins in granulocytes

  6. Benefits of Aprotinin • Blood loss reduction of 40-50% • Reduction in blood use 40-80% • May decrease systemic inflammatory reaction to CPB

  7. Adverse Effects • Study in NEJM in 2006 with 4,374 patients • 1:200 risk of anaphylaxis • Doubled risk of renal failure • Forces 10,000 patients of dialysis each year • 55% increased risk of MI or heart failure • 181% increased risk of stroke or encephalopathy

  8. Adverse Effects • Untoward events for 1st exposure 1:143 • Untoward events for 2nd exposure 1:11 • Side effects have incurred more than $1 billion in medical costs per year!

  9. Alert! • Feb. 2006, FDA issued public health advisory • Possible renal and CV toxicity • Currently, use of Aprotinin is at physician’s discretion

  10. Conclusion • What about the risk of receiving blood + aprotinin? • Should Aprotinin’s use be at the physician’s discretion? • What about safer alternatives? • Do the benefits outweigh the risks?????

More Related