[HSF] More Bad News About Trasylol

[Michael Firstenberg]

Part of the problem is that I know at least one well known surgeon  
who has been contacted by patients wondering if they got aprotinin  
during the surgery.  When they where told "no" the patients where  
disappointed that they could not enter the class action lawsuit  
lottery (even though they did fine after their surgery).  A friend of  
mind who is involved with financial planning told me that a recent  
survey of people - when asked how they plan for retirement: 1) win  
the lottery 2) sue someone.

michael


On Oct 1, 2006, at 10:58 AM, hgrmd at aol.com wrote:

> Ben,
>   I agree with the fact that a certain amount of ATN is inherent to  
> any cardiac surgery.  However, the case I cited was quite unusual  
> in that the lady never made any, and I mean any, urine during or  
> after the case.  Very unusual.  In addition, I noticed a general  
> significant increase in ATN while using aprotinin, so that I  
> stopped using it long before I ever heard or read about its  
> deleterious effect on renal function.  About 4 years ago, an  
> applicant to my group was discussing aprotinin with me, and I told  
> him of my impression that it screwed up renal function.  He advised  
> using "full dose" rather than half dose aprotinin.  I tried that,  
> and it seemed to help though I still saw it enough that I wouldn't  
> use it in patients with baseline elevation of creatinine.  Then,  
> last January, feces hit the fan when the NEJM article came out on a  
> Thursday.  By Saturday, I saw my first attorney ad regarding  
> "cardiac surgery and kidney failure."  A chill ran down my spine.
> Hal
>
>
> -----Original Message-----
> From: benjamin.bidstrup at bigpond.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: Sun, 1 Oct 2006 10:38 AM
> Subject: Re: [HSF] More Bad News About Trasylol
>
>
> Hal,
> The literature has many references to the incidence of ESR failure  
> leading to dialysis after cardiac surgery. There are many risk  
> assessments, with factors such as inotrope use, red cell  
> transfusion and pre-existing renal impairment. The paper from  
> Cooper ( Cooper, W.A., et al., Impact of renal dysfunction on  
> outcomes of coronary artery bypass surgery: results from the  
> Society of Thoracic Surgeons National Adult Cardiac Database.  
> Circulation, 2006. 113(8): p. 1063-70. )suggests that of all CABG  
> patients (STS Database data n = 483,914) the incidence of new renal  
> dialysis was 1.5%. After AVR, I have no data but it may be similar.  
> Thus 3 in 200 will get RF needing dialysis. Maybe this was one of  
> those 3. To relate a problem to 1 case is to draw a long bow, but  
> cardiac surgeons are known for their prowess in archery. Especially  
> getting the bull in the first shot.
> Need to also define renal failure, ATN etc. See this paper  
> (Kuitunen, A., et al., Acute renal failure after cardiac surgery:  
> evaluation of the RIFLE classification. Ann Thorac Surg, 2006. 81 
> (2): p. 542-6.)
>
> BTW have seen an amazing fireworks display, not in a cardiac OR but  
> on Victoria Harbour, Hong Kong.
>
>
>> Prasanna,
>> I'm glad you've never seen permanent ESRD with aprotinin--I have. In
>> fact, what tipped me off many years ago that aprotinin produced  
>> ATN was a
>> completely uneventful, easy AVR that I did on an old lady  
>> receiving >aprotinin. >After she went on the pump, she never made  
>> a drop of urine, absolutely zero. >Otherwise, she did OK, but she  
>> ended up on permanent HD. I had >never even heard
>> of aprotinin-associated ATN, but this definitely made me  
>> suspicious. Most of
>> the aprotinin-associated ATN does resolve, but some does not. As  
>> we all
>> know, ATN with dialysis requires invasive lines that can get  
>> infected. >Antibiotics can lead to C. dif. Etc, etc. >Hal
>> _______________________________________________
>> OpenHeart-L mailing list
>>
>> Send postings to:
>> OpenHeart-L at lists.hsforum.com
>>
>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>> http://mmp.cjp.com/mailman/listinfo/openheart-l
>>
>> All messages transmitted by the OpenHeart-L are subject to the  
>> policies and
>> disclaimers posted at:
>> http://www.hsforum.com/listdisclaim
>> -----------------------------------------
>
> -- Ben Bidstrup FRACS FRCSEd FEBCTS 
> Consultant Cardiothoracic Surgeon
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the  
> policies and disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
> ______________________________________________________________________ 
> __
> Check out the new AOL.  Most comprehensive set of free safety and  
> security tools, free access to millions of high-quality videos from  
> across the web, free AOL Mail and more.
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the  
> policies and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------