Drug therapy reduces risk of stroke during coronary artery bypass surgery

Treating patients with a drug called aprotinin reduces the risk of stroke by 47 percent in patients undergoing coronary artery bypass graft (CABG) surgery, according to a study published in the Journal of Thoracic and Cardiovascular Surgery.

The study, a large-scale analysis evaluating data from 35 CABG studies, determined that use of aprotinin reduced the need for a blood transfusion by 39 percent. Blood transfusions during CABG surgery have been associated with an increased risk of stroke. Stroke and neurological injury occurs in five percent of the more than 300,000 CABG surgeries performed annually. “Our results highlight that aprotinin therapy might be recommended in all primary CABG surgeries after applicability to individual centers and patients is considered,” said lead investigator Artyom Sedrakyan, M.D., researcher at Yale School of Medicine and lecturer at London School of Hygiene and Tropical Medicine. “About 10 strokes could be avoided in every 1,000 CABG patients with the use of aprotinin, which is a substantial stroke reduction benefit.”

The study also showed that aprotinin therapy was associated with a trend toward reduced atrial fibrillation and did not increase the risk of adverse events including mortality, myocardial infarction and renal failure. “The cerebroprotective and anti-inflammatory effects of aprotinin therapy in CABG surgery, associated with improved neurological outcomes, have been reported in previous studies,” said Sedrakyan, who did his work in the cardiothoracic department at Yale. “Our study further indicates that the balance of effects is positive with aprotinin use. Future studies should address the cost-effectiveness of this medication as it is substantially more costly in America as compared to the United Kingdom or the rest of Europe.”

Patients undergoing CABG surgery may be exposed to thousands of cerebral blood clots, which significantly increase the risk of stroke. Stroke associated with this type of surgery results in longer hospital stays, increased need for long-term care and a 20 percent increase in hospital mortality rates. In addition, strokes occurring several days after CABG surgery represent almost 25 percent of all cardiac surgery-related strokes.