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Does aprotium increase postoperative renal dysfunction in patients with preoperative renal insufficiency after cardiothoracic surgery using cardiopalmonary bypass?

1 August 2002

Abstract

Background: Aprotinin is a drug used to reduce postoperative bleeding in patients undergoing open heart surgery utilizing Cardiopulmonary Bypass. This serine protease inhibitor is isolated from bovine lung tissue, and is a nonspecific inhibitor of several proteinases, including trypsin, plasmin, and kallikrein. Thus, aprotinin has an antifibrinolytic effect, inhibits contact activation, reduces platelet dysfunction, and attenuates the inflammatory response to Cardiopulmonary Bypass. Currently, there exists an inadequate amount of data regarding the effect of aprotinin on patients with severe preoperative renal dysfunction who undergo open heart surgery, but not requiring dialysis.

Methods: Inclusion criteria were patients with preoperative renal insufficiency who had open-heart surgery with particular emphasis of postoperative renal insufficiency (serum creatinine > 1.5 mg/dl). Patients who received aprotinin treatment during the procedure are compared to those who did not. A total of294 medical records were reviewed retrospectively.

Results: Of the 294 patients reviewed, 204 received no aprotinin, 40 received a half dose, and 51 received a full dose. The mean estimate for pre-operative serum creatinine is 1.95 (.04) for the no aprotinin group, 2.06 (.08) for the half-dose group, and 2.02 (.08) for the full dose group (P>.05). Analysis of difference between the post-op creatinine and pre-op creatinine showed a small statistically significant increase (no aprotinin group: estimated difference 0.264, std (0 .06), t-value (4 .20), p «0.05); half dose aprotinin: 0.353 , std (0.142), t-value (2.49), p «0.05); full dose aprotinin: 0.506, std (0.12), t-value (4.04), p < 0/05). Fourteen of the 34 diabetic patients (41.2%), twenty of the 52 hypertensive patients (38.5%), and nine of the 16 peripheral vascular patients (56.3%) who received aprotinin had postoperative creatinine increases of 0.5 mg/dl or more (p>0.5, not significant). The proportion of dialysis complications for patients receiving aprotinin (14%) is not significantly different from the proportion for patients not receiving aprotinin (7.7%) (Chi-square=2.8; 1 degree of freedom; Pvalue=0.096).

Conclusion: The aprotinin-treated patients appeared to suffer a slightly greater loss of renal function, though the differences between these groups are not statistically or clinically significant. Though the need for dialysis after surgery is not significantly different between patients who received aprotinin and those who did not, we did find a higher incidence of neurological complications in the patients who received aprotinin.


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