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• W2029547056 abstract "We congratulate Poston and colleagues [1Poston R.S. White Ch Gu J. et al.Aprotinin shows both hemostatic and antithrombotic effects during off-pump coronary artery bypass grafting.Ann Thorac Surg. 2006; 81: 104-111Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar] on their interesting article dispelling a little of the concerns or fears of an increase in graft failure in off-pump coronary artery bypass grafting (OPCABG) when aprotinin is used to reduce blood loss. Last year we published the results of a prospective, randomized, double-blind study comparing hemostatic effects of tranexamic acid versus aprotinin versus placebo in OPCABG [2Vanek T. Jares M. Fajt R. et al.Fibrinolytic inhibitors in off-pump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo).Eur J Cardio-thorac Surg. 2005; 28: 563-568Crossref PubMed Scopus (47) Google Scholar]. In addition, and for safety evaluation reasons, the time course of myocardial enzymes in the very early postoperative period was assessed. We found no statistically significant intergroup differences at any time (preoperatively, 8 hours, and 24 hours postoperatively) within the time course of creatine phosphokinase (CK) levels, isoenzyme MB (CK-MB) levels and the relative index of CK-MB and CK, but troponin I levels differed between our study groups 8 hours postoperatively (p = 0.015) (Table 1).Table 1Time Course of Troponin I Levels (μg/L) in Off-Pump Coronary Artery Bypass GraftingaData are presented as geometrical means and 95% confidence intervals.Tranexamic Acid Treated Group (n = 32)Aprotinin Treated Group (n = 29)Placebo Treated Group (n = 30)p ValueBefore operation0.240 (0.128, 0.450)0.166 (0.071, 0.388)0.159 (0.068, 0.388)0.3918 Hours postoperatively0.841 (0.513, 1.376)0.380 (0.214, 0.674)1.084 (0.671, 1.753)0.01524 Hours postoperatively0.631 (0.344, 1.155)0.604 (0.321, 1.138)0.961 (0.535, 1.726)0.490a Data are presented as geometrical means and 95% confidence intervals. Open table in a new tab Post hoc tests showed above all the most significant difference between the aprotinin treated group and the placebo group (p < 0.001) due to the lowest mean values of troponin I in the aprotinin group. Twenty-four hours postoperatively the mean levels of troponin I remained lowest in the aprotinin treated group and highest in the placebo group, but these differences were already without statistical significance. We assume that our findings concerning the time course of troponin I levels support the conclusions of Poston and colleagues [1Poston R.S. White Ch Gu J. et al.Aprotinin shows both hemostatic and antithrombotic effects during off-pump coronary artery bypass grafting.Ann Thorac Surg. 2006; 81: 104-111Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar] that aprotinin shows not only hemostatic, but also antithrombotic (and probably vein graft endothelium preservation) mechanism during OPCABG. We congratulate Poston and colleagues [1Poston R.S. White Ch Gu J. et al.Aprotinin shows both hemostatic and antithrombotic effects during off-pump coronary artery bypass grafting.Ann Thorac Surg. 2006; 81: 104-111Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar] on their interesting article dispelling a little of the concerns or fears of an increase in graft failure in off-pump coronary artery bypass grafting (OPCABG) when aprotinin is used to reduce blood loss. Last year we published the results of a prospective, randomized, double-blind study comparing hemostatic effects of tranexamic acid versus aprotinin versus placebo in OPCABG [2Vanek T. Jares M. Fajt R. et al.Fibrinolytic inhibitors in off-pump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo).Eur J Cardio-thorac Surg. 2005; 28: 563-568Crossref PubMed Scopus (47) Google Scholar]. In addition, and for safety evaluation reasons, the time course of myocardial enzymes in the very early postoperative period was assessed. We found no statistically significant intergroup differences at any time (preoperatively, 8 hours, and 24 hours postoperatively) within the time course of creatine phosphokinase (CK) levels, isoenzyme MB (CK-MB) levels and the relative index of CK-MB and CK, but troponin I levels differed between our study groups 8 hours postoperatively (p = 0.015) (Table 1). Post hoc tests showed above all the most significant difference between the aprotinin treated group and the placebo group (p < 0.001) due to the lowest mean values of troponin I in the aprotinin group. Twenty-four hours postoperatively the mean levels of troponin I remained lowest in the aprotinin treated group and highest in the placebo group, but these differences were already without statistical significance. We assume that our findings concerning the time course of troponin I levels support the conclusions of Poston and colleagues [1Poston R.S. White Ch Gu J. et al.Aprotinin shows both hemostatic and antithrombotic effects during off-pump coronary artery bypass grafting.Ann Thorac Surg. 2006; 81: 104-111Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar] that aprotinin shows not only hemostatic, but also antithrombotic (and probably vein graft endothelium preservation) mechanism during OPCABG. ReplyThe Annals of Thoracic SurgeryVol. 82Issue 5PreviewAs suggested by Vanek and colleagues [1], a growing body of evidence supports the safety of aprotinin use during OPCAB. Their own report [2], published while our off-pump coronary artery bypass (OPCAB) trial in The Annals of Thoracic Surgery was in press [3], highlights two points that are becoming increasingly clear about aprotinin. First, aprotinin provides a hemostatic benefit that exceeds the lysine analogues, likely due to the ability to preserve platelet function in addition to blocking fibrinolysis. Full-Text PDF" @default.
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• W2029547056 date "2006-11-01" @default.
• W2029547056 modified "2023-10-12" @default.
• W2029547056 title "Aprotinin Reduces Troponin I Levels in OPCABG" @default.
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• W2029547056 doi "https://doi.org/10.1016/j.athoracsur.2006.03.110" @default.
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