[HSF] Aprotinin...again

Thu Feb 8 14:33:34 EST 2007

There are those that look for motives (my wife among them and she keeps me out of trouble sometimes), and those like myself who favor patterns. Notoriety may lean toward the former. I would just note that while many can be wrong, only a few can be a hero  in the process.
Not that I am not also interested in other perspective of personality or insight either. 
tea

----- Original Message ----
From: Donald Ross <donross at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, February 8, 2007 4:18:05 PM
Subject: Re: [HSF] Aprotinin...again

Can anyone tell me why this Mangano fellow carries on such a flawed  
but successful campaign against Aprotinin? Is there any other angle  
other than notoriety?
The consensus is that it is a very useful drug which probably doesn't  
have any nephrotoxicity and its restriction in US will probably  
result in increased morbidity.
We still use it in our unit ( even opcab if there is obvious   
platelet suppression ) but our patients are not yet so rapaciously  
canvassed by  lawyers.
Don
On 09/02/2007, at 8:17 AM, Tea Acuff wrote:

> Since most of my cases are without CPB, I may use it less than you.  
> But thanks for the reminder.
> tea
>
>
> ----- Original Message ----
> From: "hgrmd at aol.com" <hgrmd at aol.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Thursday, February 8, 2007 5:30:06 AM
> Subject: Re: [HSF] Aprotinin...again
>
>
> Tomas,
>   Like Ani, my office got 3 calls regarding aprotinin from  
> concerned patients.  I hate to tell Ani, Tea, Ben, and others "I  
> told you so", but I told you so.  My use has and will be limited to  
> thoracic aortic grafts and patients already on dialysis.
> Hal
>
>
> -----Original Message-----
> From: TSalerno at med.miami.edu
> To: OpenHeart-L at lists.hsforum.com; OpenHeart-L at lists.hsforum.com
> Sent: Thu, 8 Feb 2007 1:46 AM
> Subject: RE: [HSF] Aprotinin...again
>
>
> My patients, even done in 2003, are now calling in panic and I am  
> sure will be
> part of a class action lawsuit for the use of aprotinin. The use of  
> this drug in
> the USA is in jeopardy and I personally will not use it outside the  
> guidelines
> given by FDA. We now have to make legal decisions...
>
>
> Tomas
>
> ________________________________
>
> From: openheart-l-bounces at lists.hsforum.com on behalf of Ben Bidstrup
> Sent: Wed 2/7/2007 10:45 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Aprotinin...again
>
>
>
>> I was wondering if anyone has read the new Mangano paper? It appears
>> that regardless of veracity or scientific accuracy it will inflict a
>> major, if not irreversible blow on the use of this agent. We have
>> had 3 patients calling today wanting to know if they received the
>> drug and I am sure there will be numerous more. Although I have been
>> a strong believer in aprotinin for years, I have a sad feeling that
>> its end may be nigh except in the complex high risk case.
>>
>> I suspect that this paper has all the flaws of the first, I will
>> read it myself and find out, but the suggestion that patients are at
>> increased risk of dying up to five years later is one few patients
>> will ignore.
>>
>> Ani
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>
>
> If Mangano analysed his data with risk stratification (say Euroscore)
> and it came out with the conclusion that mortality risk adjusted was
> higher, then it would be far more persuasive than this most recent
> attempt. As he has in the past scored patients with Euroscore, he
> probably has the correct elements to do this. Hopefully properly
> defined as well. But given the attitude he presented at the FDA
> hearing, his unwillingness to let anyone look at the raw data I agree
> that this is as flawed as the earlier reports. High risk patients
> will die sooner than low risk. I believe we already know that.
>
> I am an unashamed supporter of my early research on aprotinin and
> much of it has been funded by industry (Bayer). I have received other
> support from Bayer in terms of Speaker Bureau and consultancy fees. I
> also have done work for many other companies.
> I might add that much research these days is supported by industry as
> other funds are few and far between.
>
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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