"Our study is important because it shows that if aprotinin is used selectively and a drug/lab test interaction is avoided, the drug does not hurt patients' hearts or brains while reducing their need for blood transfusions and reoperations for bleeding," said C. Michael White, Pharm.D., of Hartford Hospital in Hartford, Conn., one of the study authors.
The study was prompted by recent reports suggesting an increased risk of complications—including heart attacks, strokes, and kidney problems—in patients who received aprotinin to reduce bleeding during heart bypass or valve replacement surgery. In response, the U.S. Food and Drug Administration issued an alert limiting the use of aprotinin during heart surgery.
Dr. White and colleagues performed a similar study, but limited to patients treated at Hartford Hospital, where aprotinin was used differently than at most other hospitals. "We thought our results might be different than what most hospitals had seen, because at Hartford Hospital, we reserved drug therapy to patients who would most benefit and we avoided a drug/laboratory test interaction that could have resulted in an increased risk of blood clots," according to Dr. White.
The analysis included 3,348 patients undergoing bypass or valve replacement surgery at Hartford Hospital from 2000 through 2005. In contrast to the previous study, there was no increase in heart attack risk among patients receiving aprotinin, while the risk of stroke was 35 percent lower.
As in the previous study, patients receiving aprotinin had an increased risk of kidney dysfunction after surgery. It was not clear whether the kidney problems were permanent or temporary.
One reason for the conflicting results is that Hartford Hospital limited the use of aprotinin to patients undergoing particularly complex operations (and to patients like Jehovah's Witnesses, who refuse blood transfusions).
Another reason was that the Hartford Hospital doctors avoided a specific lab/drug test interaction that can lead to inadequate anti-clotting treatment. "During bypass or heart valve surgery, patients receive a drug called heparin to prevent blood clot formation," Dr. White explained. "Surgery teams know how much to give because they measure the activated clotting time (ACT). Previous studies have found that aprotinin makes the ACT rise erroneously if celite-ACTs are used. If you are using celite-ACTs to guide heparin dosing in a patient treated with aprotinin, you will think you gave enough heparin when in fact you didn't." This interaction may explain some of the increased risks with aprotinin reported in previous studies.
However, Dr White did not want to dismiss the importance of the previous studies showing harm. "Those studies were important, because they clearly showed that the way aprotinin was used around the world, by and large, was hurting patients more than helping them," said Dr. White. "By using aprotinin selectively and avoiding the celite-ACT test, surgical teams can reduce the risk of bleeding problems during surgery without increasing the risks of heart attack or stroke."
Jayne Dawkins | alfa
Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung
Scientists reveal source of human heartbeat in 3-D
07.08.2017 | University of Manchester
Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.
As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...
Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.
Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...
For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.
While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...
An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.
The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...
A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.
Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...
16.08.2017 | Event News
04.08.2017 | Event News
26.07.2017 | Event News
21.08.2017 | Materials Sciences
21.08.2017 | Health and Medicine
21.08.2017 | Materials Sciences