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Anesth Analg 2007; 105:949-962
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000281936.04102.9f
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Aprotinin in Cardiac Surgery
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CARDIOVASCULAR ANESTHESIOLOGY

Aprotinin in Cardiac Surgery: A Review of Conventional and Novel Mechanisms of Action

Matthew D. McEvoy, MD*, Scott T. Reeves, MD*, J. G. Reves, MD*, and Francis G. Spinale, MD, PhD{dagger}

From the *Department of Anesthesia and Perioperative Medicine, and {dagger}Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.

Address correspondence and reprint requests to Matthew D. McEvoy, MD, MUSC Department of Anesthesiology and Perioperative Medicine, 165 Ashley Ave., CH 525, Charleston, SC 29425. Address e-mail to mcevoymd{at}musc.edu.

Abstract

Induction of the coagulation and inflammatory cascades can cause multiorgan dysfunction after cardiopulmonary bypass (CPB). In light of these observations, strategies that can stabilize the coagulation process as well as attenuate the inflammatory response during and after cardiac surgery are important. Aprotinin has effects on hemostasis. In addition, aprotinin may exert multiple biologically relevant effects in the context of cardiac surgery and CPB. For example, it decreases neutrophil and macrophage activation and chemotaxis, attenuates release and activation of proinflammatory cytokines, and reduces oxidative stress. Despite these perceived benefits, the routine use of aprotinin in cardiac surgery with CPB has been called into question. In this review, we examined this controversial drug by discussing the classical and novel pathways in which aprotinin may be operative in the context of cardiac surgery.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.