Low postoperative dose of aprotinin reduces bleeding and is safe in patients receiving clopidogrel before coronary artery bypass surgery. A prospective randomized study.

The authors evaluated a standard high dose (6 million KIU) vs. a postoperative low dose (1 million KIU) of aprotinin to decrease bleeding and transfusions in patients treated with clopidogrel and aspirin undergoing on-pump coronary artery bypass surgery. Low-dose aprotinin was shown to be as effective as the high dose regimen but was associated with an increased incidence of platelet transfusions. High-dose aprotinin was, on the other hand, associated with an increased need for inotropic agents (P = 0.006) and increased mortality (2% vs. 0.05%, P = 0.22). Despite the absence of statistical significance, the number of patients included was too small to exclude a type 2 error regarding mortality. Despite their potential efficacy, future “aprotinin-like” drugs will require an extensive evaluation of safety before they can be adopted in routine clinical practice.

– Jean-Franois Hardy