[HSF] Aprotinin

[Ajit Damle]

Dr. Bender,

I marvel at your ability of doing a 77 yr old AVR+CABG loosing only 2%
hematocrit. Is that usual for you?

Ajit Damle


-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Ani Anyanwu
Sent: Thursday, September 20, 2007 12:28 PM
To: openheart-l at lists.hsforum.com
Subject: RE: [HSF] Aprotinin

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
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