[HSF] I used aprotinin today

[Ani Anyanwu]

Carmi
 
I would not discount using aprotinin on your patient. As long as it remains on the market it remains a valid treatment option and like all others, one must weigh the pros and cons. There are many patients and physicians who swear by vioxx and would still use it if Merck had not withdrawn it.
 
I used aprotinin today in a patient I did a heart transplant in whom I had placed an implantable left ventricular assist device a few months ago. He was therefore a tough reop and was also on warfarin and clopidogrel till this morning and started surgery with an INR > 2 and Hb of 9. There are several ways one can play this game including tons and tons of plasma and platelets and risk a failing right heart and a failing allograft or pharmacology combined with judicious use of products.
 
While I will reluctantly give up its use as a 'convenience drug', in cases where there is a *perception* that its use could significantly influence outcome (such as in a Jehovah's Witness) I believe we are duty bound to recommend its use to our patients. Of course when (because it seems a matter of time) it is withdrawn from the market then we do not have a choice, but for now aprotinin is still an FDA approved drug and remains an option to consider in high risk patients.
 
Ani
 



> From: Cysmd613 at aol.com> Date: Wed, 7 Nov 2007 23:01:28 -0500> Subject: Re: [HSF] Aprotinin> To: OpenHeart-L at lists.hsforum.com> CC: > > As I posted last week, I used aprotinin for an ascending and arch replacement > in a patient with an aortic dissection. His creatinine bumped up only to > 2.1, but came down to 1.5. He never was oligric and the bump in creatinine > probably was due to the pump run rather than the aprotinin. Overall he is doing > well except for a little disorientation and slightly slurred speech (small > occiptial infarct by CT scan).> > I did a redo AVR last week on a 74 yo woman who had previous AVR (porcine) > and CABG 7 years ago (valve calcified) . She had mild chronic renal > insufficiency, so I used amicar instead of aprotinin. This morning the patient's husband > asked me whether I used aprotinin during her operation.> > I'm planning to operate on an 80 yo woman Jehovah's Witness with severe 3 > vessel CAD not amenable to PTCA, s/p NSTEMI 4 days ago. She had received a > loading dose of Plavix 300mg and then was on 75mg daily for a couple of days. Her > Hgb has dropped from 14 to 12.7 She is a little lady, so I would like to see > her Hgb at least 14. In patients such as her, I would use aprotinin, but now > I don't know if I can. I have asked the hospital physician administrator > whether it can be used after the FDA withdrawal.> > Any suggestions?> > Carmi Stadlan> > > > ************************************** See what's new at http://www.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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