[HSF] More Bad News About Trasylol

[Ajit Damle]

For my two cents worth, I too, use Aprotinin in all pump cases, although at
a reduced dose (1+1) for CABGs, unless they are high risk. My incidence of
ATN, rise in creatinine, or renal failure, dialysis, stroke, MI is no
different than the STS database, and observed/predicted mortality ratio <1. 

Again, like Tom Martin and RSB, for anecdotal and subjective information
only. 

Ajit Damle
Fargo ND


-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of
rsboova at comcast.net
Sent: Sunday, October 01, 2006 8:43 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] More Bad News About Trasylol

Entering this discussion late  but my experience is routine use of full dose
Aprotinin for all CPB cases .
Rarely have seen significant renal insufficiency  and don't recall ever
having case result in end stage renal failure or permanent hemodialysis .
Patients are advanced age , complex , and advanced risk due to multiple
co-morbidities which is why I have used Aprotinin to eliminate post
operative bleeding as another complicating factor . ( previously thought  to
have CNS protective effect as you know ) 
Have used since aprotinin was available and consistently  seems to have been
a benefit for CPB cases 
Anecdotal and subjective  information only
 none the less have not changed pattern of  aprotinin use since NEJM article
published  
Still no change in outcomes No plan to change 
RSB 

-------------- Original message -------------- 
From: Tdmartin2000 at aol.com 

> Don't believe everything you read in the New York times. The FDA panel as
I 
> understand it was very critical of the Mangano paper in the NEJM and the 
> initial committee review was in favor of Aprotinin, The problem with the
study 
> that 
> was not reviewed was that the Bayer folks didn't even let the panel know
that 
> the study was being done or was near completion. 
> 
> My prediction is that aprotinin will be vindicated on most accounts. 
> Bleeding and transfusions are bad and should be avoided if at all
possible. I 
> can only relate that in the JHW group we use aprotinin in every case
(along 
> with a lot of other measures) and anecdotally we have fewer complications
in 
> this group. 
> I too have nothing to do with the Bayer corp. 
> 
> Tom Martin 
> U of Florida 
> Gainesville 
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