The Risk Associated with Aprotinin Cardiac Surgery - http://content.nejm.org/cgi/content/abstract/354/4/353The majority of patients who undergoing surgical treatment for ST-elevation heart attacks receive antifibrinolytic therapy to limit blood loss. This approach appears counterintuitive to the accepted medical treatment of the same condition - namely, fibrinolysis (blood clots) to limit thrombosis. Despite this concern, no large-scale safety assessment has been undertaken.
An observational study was done with 4,374 patients undergoing revascularization (reviving the heart). Three agents were assessed: 1,295 patients were administered aprotinin (Trasylol), 883 patients were administered aminocaproic acid, and 882 patients received tranexamic acid while 1,374 patients received nothing.
The use of aprotinin was associated with a doubling in the risk of renal failure requiring dialysis among patients undergoing complex coronary-artery. Similarly, use of aprotinin was associated with a 55 percent increase in the risk of heart attack or heart failure and a marked increase in the risk of stroke or encephalopathy (brain disease associated with dementia).
Neither aminocaproic acid nor tranexamic acid was associated with an increased risk of renal, cardiac, or cerebral events. All the agents reduced blood loss but with aprotinin - at what risk?
In contrast, the less expensive generic medications -- aminocaproic acid and tranexamic acid are safe alternatives.
