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CARDIOVASCULAR ANESTHESIA

Plasma Aprotinin Concentrations During Cardiac Surgery: Full- Versus Half-Dose Regimens

Susan M. Beath, MD^*, Gregory A. Nuttall, MD, David N. Fass, PhD, William C. Oliver, Jr., MD, Mark H. Ereth, MD, and Lance J. Oyen, Pharm D BCPS^§

Departments of *Cardiovascular Anesthesiology and Anesthesiology, Mayo Graduate School of Medicine; and Departments of Biochemistry and Molecular Biology, and §Hospital Pharmacy, Mayo Clinic, Rochester, Minnesota

Address correspondence and reprints requests to Gregory A. Nuttall, MD, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905. Address e-mail to nuttall.gregory{at}mayo.edu

Aprotinin is an effective but expensive drug used during cardiac surgery to reduce blood loss and transfusion requirements. Currently, aprotinin is administered to adults according to a fixed protocol regardless of the patient’s weight. The purpose of this study was to determine aprotinin levels in patients receiving full- and half-dose aprotinin regimens by a simple functional aprotinin assay and to design a more individualized aprotinin dosage regimen for cardiac surgical patients. The mean plasma aprotinin concentration peaked 5 min after the initiation of cardiopulmonary bypass (full 401 ± 92 KIU/mL, half 226 ± 56 KIU/mL). The mean plasma aprotinin concentration after 60 min on cardiopulmonary bypass was less (full 236 ± 81 KIU/mL, half 160 ± 63 KIU/mL). There was large variation in the aprotinin concentration among patients. A statistically significant correlation was found between aprotinin concentration and patient weight (r² = 0.67, P < 0.05).

Implications: The current dosing schedule for aprotinin results in a large variation in aprotinin plasma concentrations among patients and a large variation within each patient over time. We combined the information provided by our study with that of a previous pharmacokinetic study to develop a potentially improved, weight-based, dosing regime for aprotinin.

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