[HSF] Aprotinin

[Edward Bender]

Fairly typical but takes additional time and effort.  I really should  
apply these same principles to the rest of my patient population.

Ed Bender, MD

On Sep 21, 2007, at 3:47 AM, Ajit Damle wrote:

> 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
> 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>
> -----------------------------------------
> _________________________________________________________________
> Feel like a local wherever you go.
> http:// 
> www.backofmyhand.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
> -----------------------------------------
>
> _______________________________________________
> 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
> -----------------------------------------