[HSF] Aprotinin

[psimha]

That is my premise - You should treat everyone like a JW if you want to 
reduce transfusions.
Prasanna
Edward Bender wrote:
> 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
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