[HSF] More Bad News About Trasylol

[DukeB60 at aol.com]

Hal,
    Our most recent evaluation of our surgical outcomes  for the year to date 
2006 showed very acceptable numbers for all  parameters with the exception of 
renal dysfunction post pump - valve  or CABG or "other."  We are evaluating 
ways to improve this data but to  suggest aprotonin is the culprit would be 
difficult inasmuch as I use Trasylol  on almost all cases and my partner uses it 
on none, yet the incidence of post-op  renal dysfunction is identical.   I 
tend to do more complex cases but  there is no difference in the incidence of 
post-op renal problems.  We are  looking at calculating creatinine clearance more 
frequently to predict more  accurately patients at risk and to manage them 
differently pre-operatively to  avoid post-op problems.  But to impulsively 
point the finger at aprotonin  alone in response to articles recently published in 
the NEJM and the NY Times  would appear to beg the question and potentially 
focus on the wrong cause(s) of  the problem.   Not to mention ignore the 
history of the drug so well  outlined by Ben.
    By carefully examining practice  patterns when our results were not where 
we wanted them to be in other  measured areas, the outcomes have always come 
into line, and I suspect renal  dysfunction after CPB will as well.  But the 
cause and effect is more  complex than simply implicating one drug, especially 
when there are well  recognized benefits to it's use and very definite 
negative implications in  the indiscriminate use of blood products.  
    Aprotonin very well may contribute to post op renal  dysfunction but our 
data currently suggests there is/are other factors at  play. Perhaps with the 
help of our nephrologists and careful assessment of  individual patient risk 
we hopefully can implement an effective pattern of  management to reduce renal 
problems that not only increase operative risk but  increase length of stay 
and the potentially unnecessary consumption of  resources.
 
Edward P.  Raines, M.D., J.D.
BryanLGH Cardiothoracic Surgery
BryanLGH Medical Center  East
1600 South 48th Str.
Lincoln, Nebraska 68506
Cell  402-730-9242
Office 402-481-8430
Fax  402-481-8429