[HSF] Aprotinin

[Ani Anyanwu]

Ed
 
I suspect this is not also the first case of dead bowel you have seen in 10 years so unfortunately this association would be difficult if not impossible to prove. I use aprotinin almost every day and have not seen dead bowel 'in a while'.
 
However if a patient (presumably) thrombosed their stents within 2 months it raises possibility of a prothrombotic patients and antifibrinolytic drugs of any sort should be used with caution in such patients (if at all). In an elective setting such a patient would ideally undergo screening for thrombophilic states. 
 
On a separate note it is interesting your cardiologist chose to treat CAD co-existing with aortic stenosis with a drug eluting stent but I suppose that is a discussion for another day. You should consider dual antiplatelet therapy with clopidogrel if she survives as we recently had such a patient with early stent occlusion who presented shortly after CABG with an MI and found to have blocked five of her grafts.
 
Ani



> Date: Thu, 20 Sep 2007 12:20:11 -0400> From: ebender001 at charter.net> To: OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF] Aprotinin> > Two days ago I did an aortic valve, cabg on a 77 year old Jehovah's Witness patient. She had drug eluting stents placed two months previously in the ramus and LAD. She returned to the ER with an MI, a 90% ostial and 70% mid LAD stenosis, 70% ramus stenosis, and an aortic valve mean gradient of 50 mmHg. Because of ongoing ischemia, an intra-aortic balloon pump was placed in the cath lab, resolving her chest pain and ST segment depression. Her starting hematocrit was 33. She would not accept blood under any circumstance. The case went without a problem, and she had a post-op hematocrit of 31. She transferred out of the ICU on post-op day 1 without any issues. She developed shortness of breath and abdominal distention with a drop in blood pressure that night. The bottom line is that she got a laparotomy this morning (post-op day 3) and had a deat right colon removed.> > This is the only case in the last 10 years that I have used aprotinin, and I am wondering about causation. She had an episode of atrial fib during the time she was developing shortness of breath. TEE during the heart surgery showed no left atrial clot. The aortic annulus was not very calcified, requiring very little debridement. I know the etiology of the dead bowel is not proveable, but I wonder about the effects of aprotinin. Any comments?> > Ed Bender, MD> _______________________________________________> 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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