Aprotinin for coronary bypass operations: Efficacy, safety, and influence on early saphenous vein graft patency. A multicenter, randomized, double- blind, placebo-controlled study

J. H. Lemmer, W. Stanford, S. L. Bonney, J. F. Breen, E. V. Chomka, W. J. Eldredge, W. W. Holt, R. B. Karp, G. W. Laub, M. J. Lipton, Hartzell V Schaff, C. J. Tatooles, J. A. Rumberger, B. P. Bidstrup, S. Attar

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Abstract

The purpose of this study was to evaluate the efficacy and safety of aprotinin in a U.S. population of patients undergoing coronary artery bypass grafting. Early vein graft patency rates were assessed by ultrafast computed tomography. A total of 216 patients at five centers were randomized to receive either high-dose aprotinin or placebo during the operation; 151 patients underwent primary operation, and 65 underwent repeat procedures. Total blood product exposures in the primary group were 2.2 per patient receiving aprotinin as compared with 5.7 per patient receiving placebo (p = 0.010). The repeat group had 0.3 exposures per patient receiving aprotinin as compared with 10.7 per patient receiving placebo (p = <0.001). Consistent reductions in the percent of patients requiring donor red blood cells and in the number of units of platelets, fresh frozen plasma, and cryoprecipitate required were associated with the use of aprotinin in both primary and repeat groups. Mortality was 5.6% in the aprotinin group and 3.7% in the placebo group (p = 0.517). In the primary group, clinical diagnoses of myocardial infarction were made in 8.9% of patients receiving aprotinin as compared with 5.6% of the patients receiving placebo (p = 0.435). In the repeat group, infarctions occurred in 10.3% of patients receiving aprotinin and 8.3% of patients receiving placebo (p = 1.000). Secondary analysis of electrocardiograms and available enzyme data showed no significant difference in infarction rates between the treatment groups. There was no difference in clinically significant renal dysfunction. The early vein graft patency rates were 92.0% in the aprotinin group and 95.1% in the placebo group (p = 0.248). In this study, aprotinin was effective in reducing bleeding and blood product transfusion rates, and its use was not associated with an increase in complications. An adverse effect on early vein graft patency rates was not demonstrated, but the number of grafts assessed was insufficient for absolute conclusions in this regard.

Original languageEnglish (US)
Pages (from-to)543-553
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume107
Issue number2
StatePublished - 1994

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Aprotinin
Saphenous Vein
Placebos
Transplants
Safety
Veins
Infarction
Blood Cell Count
Coronary Artery Bypass
Blood Transfusion
Electrocardiography
Blood Platelets
Erythrocytes
Myocardial Infarction
Tomography
Tissue Donors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Aprotinin for coronary bypass operations : Efficacy, safety, and influence on early saphenous vein graft patency. A multicenter, randomized, double- blind, placebo-controlled study. / Lemmer, J. H.; Stanford, W.; Bonney, S. L.; Breen, J. F.; Chomka, E. V.; Eldredge, W. J.; Holt, W. W.; Karp, R. B.; Laub, G. W.; Lipton, M. J.; Schaff, Hartzell V; Tatooles, C. J.; Rumberger, J. A.; Bidstrup, B. P.; Attar, S.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 107, No. 2, 1994, p. 543-553.

Research output: Contribution to journalArticle

Lemmer, JH, Stanford, W, Bonney, SL, Breen, JF, Chomka, EV, Eldredge, WJ, Holt, WW, Karp, RB, Laub, GW, Lipton, MJ, Schaff, HV, Tatooles, CJ, Rumberger, JA, Bidstrup, BP & Attar, S 1994, 'Aprotinin for coronary bypass operations: Efficacy, safety, and influence on early saphenous vein graft patency. A multicenter, randomized, double- blind, placebo-controlled study', Journal of Thoracic and Cardiovascular Surgery, vol. 107, no. 2, pp. 543-553.
Lemmer, J. H. ; Stanford, W. ; Bonney, S. L. ; Breen, J. F. ; Chomka, E. V. ; Eldredge, W. J. ; Holt, W. W. ; Karp, R. B. ; Laub, G. W. ; Lipton, M. J. ; Schaff, Hartzell V ; Tatooles, C. J. ; Rumberger, J. A. ; Bidstrup, B. P. ; Attar, S. / Aprotinin for coronary bypass operations : Efficacy, safety, and influence on early saphenous vein graft patency. A multicenter, randomized, double- blind, placebo-controlled study. In: Journal of Thoracic and Cardiovascular Surgery. 1994 ; Vol. 107, No. 2. pp. 543-553.
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abstract = "The purpose of this study was to evaluate the efficacy and safety of aprotinin in a U.S. population of patients undergoing coronary artery bypass grafting. Early vein graft patency rates were assessed by ultrafast computed tomography. A total of 216 patients at five centers were randomized to receive either high-dose aprotinin or placebo during the operation; 151 patients underwent primary operation, and 65 underwent repeat procedures. Total blood product exposures in the primary group were 2.2 per patient receiving aprotinin as compared with 5.7 per patient receiving placebo (p = 0.010). The repeat group had 0.3 exposures per patient receiving aprotinin as compared with 10.7 per patient receiving placebo (p = <0.001). Consistent reductions in the percent of patients requiring donor red blood cells and in the number of units of platelets, fresh frozen plasma, and cryoprecipitate required were associated with the use of aprotinin in both primary and repeat groups. Mortality was 5.6{\%} in the aprotinin group and 3.7{\%} in the placebo group (p = 0.517). In the primary group, clinical diagnoses of myocardial infarction were made in 8.9{\%} of patients receiving aprotinin as compared with 5.6{\%} of the patients receiving placebo (p = 0.435). In the repeat group, infarctions occurred in 10.3{\%} of patients receiving aprotinin and 8.3{\%} of patients receiving placebo (p = 1.000). Secondary analysis of electrocardiograms and available enzyme data showed no significant difference in infarction rates between the treatment groups. There was no difference in clinically significant renal dysfunction. The early vein graft patency rates were 92.0{\%} in the aprotinin group and 95.1{\%} in the placebo group (p = 0.248). In this study, aprotinin was effective in reducing bleeding and blood product transfusion rates, and its use was not associated with an increase in complications. An adverse effect on early vein graft patency rates was not demonstrated, but the number of grafts assessed was insufficient for absolute conclusions in this regard.",
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AU - Lemmer, J. H.

AU - Stanford, W.

AU - Bonney, S. L.

AU - Breen, J. F.

AU - Chomka, E. V.

AU - Eldredge, W. J.

AU - Holt, W. W.

AU - Karp, R. B.

AU - Laub, G. W.

AU - Lipton, M. J.

AU - Schaff, Hartzell V

AU - Tatooles, C. J.

AU - Rumberger, J. A.

AU - Bidstrup, B. P.

AU - Attar, S.

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N2 - The purpose of this study was to evaluate the efficacy and safety of aprotinin in a U.S. population of patients undergoing coronary artery bypass grafting. Early vein graft patency rates were assessed by ultrafast computed tomography. A total of 216 patients at five centers were randomized to receive either high-dose aprotinin or placebo during the operation; 151 patients underwent primary operation, and 65 underwent repeat procedures. Total blood product exposures in the primary group were 2.2 per patient receiving aprotinin as compared with 5.7 per patient receiving placebo (p = 0.010). The repeat group had 0.3 exposures per patient receiving aprotinin as compared with 10.7 per patient receiving placebo (p = <0.001). Consistent reductions in the percent of patients requiring donor red blood cells and in the number of units of platelets, fresh frozen plasma, and cryoprecipitate required were associated with the use of aprotinin in both primary and repeat groups. Mortality was 5.6% in the aprotinin group and 3.7% in the placebo group (p = 0.517). In the primary group, clinical diagnoses of myocardial infarction were made in 8.9% of patients receiving aprotinin as compared with 5.6% of the patients receiving placebo (p = 0.435). In the repeat group, infarctions occurred in 10.3% of patients receiving aprotinin and 8.3% of patients receiving placebo (p = 1.000). Secondary analysis of electrocardiograms and available enzyme data showed no significant difference in infarction rates between the treatment groups. There was no difference in clinically significant renal dysfunction. The early vein graft patency rates were 92.0% in the aprotinin group and 95.1% in the placebo group (p = 0.248). In this study, aprotinin was effective in reducing bleeding and blood product transfusion rates, and its use was not associated with an increase in complications. An adverse effect on early vein graft patency rates was not demonstrated, but the number of grafts assessed was insufficient for absolute conclusions in this regard.

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