[HSF] Aprotinin

[Hgrmd at aol.com]

Bob,
  I would whole heartedly agree with you that Ben's opinion on  aprotinin is 
not shaped by the fees he has received.  I've met him on a  couple of 
occasions, and am convinced he is an honest man.  He and others  are convinced that 
aprotinin doesn't contribute to renal failure.   That has not been my 
impression.  This will only be resolved with more  experience and data collection.  
Believe me, I'd love to use it on every  case, because I have as many problems 
with coagulopathy as most cardiac  surgeons.  Years ago, I adopted Pat Daley's 
protocol for EACA.  Ten  grams was given at induction, ten grams at 
heparinization, and 10 grams after  protamine.  I swear I didn't take a single patient 
back for bleeding for 9  months.  However, I abandoned the protocol after 
watching a little lady  with 5 grafts close everything but the LIMA.  This happened 
as I was  closing the chest.  I crashed back on and redid the vein grafts, but 
it was  too late.  I think we are dancing on a pin with these drugs on one 
hand,  and coagulopathy on the other.
Hal