[HSF] Aprotinin

Wed Nov 7 16:18:51 EST 2007

Yes was patient who has had 5 prior replacements since 1974, last two surgeries (and this) were for paravalvar leaks around a mechanical valve, again a testament that mechanical valves do not last forever. Was hell but she is doing okay so far. I had wanted to do a heart transplant rather than a sixth reoperation but Dr Adams felt we should give another shot at rereplacement - if this valve fails then we would transplant her.

Ani

> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Aprotinin> Date: Wed, 7 Nov 2007 08:51:02 -0500> From: hgrmd at aol.com> CC: > > > Ani,> >   Sixth time reop MVR?  My god, I've only done as far as 4 times.  That must have been hell.> >   Again, my concern with aprotinin lies mainly with its potential legal liability.  Indeed, I like the drug for circulatory arrest and dialysis patients.  It may not be fair, but it's medical life in America.> > Hal> > > -----Original Message-----> From: Ani Anyanwu <anianyanwu at hotmail.com>> To: openheart-l at lists.hsforum.com> Sent: Wed, 7 Nov 2007 8:00 am> Subject: RE: [HSF] Aprotinin> > > > > Hal> > here is no mounting evidence that aprotinin is dangerous - the overwhelming > vidence by far is that it is safe. What is mounting is the perception that it > s unsafe. Remember that aprotinin is 20 years old. There are numerous studies > n the literature, many randomized, on aprotinin the majority of which have not > ound any adverse effects. A metaanalysis in JTCVS few years ago confirmed > atient benefit. All the present feelings on the drug are prompted not by > vidence (as it overwhelmingly suggests benefit) but by the results of two > tudies, one of which is very questionable, the other we are awaiting. The > nalogy is if a paper is published today showing you are more likely to die in 5 > ears if you have a mitral repair and based on that we all stop repairing > alves. It reminds me of the two flawed lancet papers few years ago linking the > MR vaccine to autism which received all the press and reduced uptake of the MMR > o 50% sporadic outbreaks of measles. All the lay media, lawyers and many > octors caught on with this. Now the papers have all been discredited and > etracted by the lancet for flaws that were very evident on the first read. All > ut 3 of the original authors wrote a retraction acknowledging the paper was > naccurate and misleading. The three remaining authors are facing the UK medical > ouncil for scientific fraud. The lead author, who like the aprotinin killers, > ad questionable motive fors lancet papers, now makes a living in the USA > orking with autism groups - a celebrity made by what is now accepted to be > yped up fabrication. Unfortunately like with aprotinin the damage was already > one, people have suffered and people remain skeptical. My understanding is thus > ar the Mangano group have not allowed others independent access to their data, > ut it wont surprise me if that one is also withdrawrn too. I for one will await > his new paper but suspect it will turn out to be no evidence on which > ithdrawal of a drug will be based. > > ind you Hal, we ALL agree on the benefits of the drug - it is the risks we > onder about. Even yourself used it in selected patients like circulatory > rrest. Why? I do not think tranexamic acid and EACA are the solution and > uspect that if given enough in a like for like dosage, it is antifibrinolysis > ather than aprotinin that is potentially harmful.> > am afraid though that this discussion is now academic. Regardless of the truth > protinin will likely be a historical drug. We had no problems administering > protinin in the past but this week all patients furnished with the information > hat the company has stopped marketing it have refused use of the drug. If the > ompany choses to stop marketing either they know something we don't (i.e. drug > s really dangerous) or they are scared FDA will mandate a withdrawal (thus > re-empting) or they are scared of lawyers. Neither is good and I cannot see how > he confidence of patients and doctors can be restored.> > e will have a meeting next week to decide on alternatives to aprotinin - we > ave no choice than to accept the reality and move on. Having said that I did a > ixth time reop MVR yesterday with no aprotinin and she is doing fine. So maybe > t is after all a convenience drug which we can do without.> > ni> > > > > > From: Hgrmd at aol.com> Date: Wed, 7 Nov 2007 07:24:54 -0500> Subject: Re: [HSF] > protinin> To: OpenHeart-L at lists.hsforum.com> CC: > > Tony,> I'll be happy to > ait for the "final analysis". If aprotinin is truly > vindicated and re > eleased on the market, I will consider using it for certain > cases. However, I > elieve all of this breast beating bluster on HSF by some > aprotinin believers, > n spite of mounting evidence of it's potential danger, > may cause some regret > n the near future. I certainly hope not, but I do think > one is definitely > aking a chance in persisting in using a drug with well > publicized questions > bout its safety. > > Hal> > > > ************************************** See > hat's new at http://www.aol.com> _______________________________________________> > penHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > > o UNSUBSCRIBE, to CHANGE email address, or to view archives:> > ttp://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by > he OpenHeart-L are subject to the policies and > disclaimers posted at:> > ttp://www.hsforum.com/listdisclaim> -----------------------------------------> ________________________________________________________________> 00’s of Music vouchers to be won with MSN Music> ttps://www.musicmashup.co.uk_______________________________________________> penHeart-L mailing list> Send postings to:> OpenHeart-L at lists.hsforum.com> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> ttp://mmp.cjp.com/mailman/listinfo/openheart-l> All messages transmitted by the OpenHeart-L are subject to the policies and > isclaimers posted at:> ttp://www.hsforum.com/listdisclaim> ----------------------------------------> > > ________________________________________________________________________> Email and AIM finally together. You've gotta check out free AOL Mail! - http://mail.aol.com> _______________________________________________> 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> -----------------------------------------
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