[HSF] Aprotinin

[Claudia Teles]

Fully agree.
I have already seen acute thrombotic events like this with rVIIa but never
with aprotinin.
Claudia


2007/9/20, Steven Schwartz <smschwartz at mac.com>:
>
> Probably coincidental to the Aprotinin.
> Much more likely to be atheroemboli in a 77 yo with AS and multi-
> vessel CAD.
> Check the path specimen.
> Steven Schwartz
>
> On Sep 20, 2007, at 9:20 AM, ebender001 at charter.net wrote:
>
> > 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
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-- 
Claudia Teles
Hemostasis Section - INCARDIO