Aprotinin: Twenty-five years of claim and counterclaim

摘要

The coagulopathy after blood-foreign surface interaction in the cardiopulmo-nary bypass circuit is part of the "postperfusion syndrome," which historically has accounted for as many deaths as has cardiac insufficiency. Cardiopulmo-nary bypass induces platelet dysfunction, thrombin production, and plasmin release.1 These changes provide the basis for postoperative hemorrhage, cardiac tamponade, and the need for surgical re-entry or excessive blood transfusion. Antiplatelet therapy in patients with coronary artery disease further compounded these effects. In turn, transfusion of packed red blood cells and coagulation components is recognized to increase the risk of morbidity and mortality after cardiac surgery~2.3#