Case 4-2007. Aprotinin-induced cardiovascular collapse after a negative test dose in a patient scheduled for repeat mitral valve surgery.

摘要

APROTININ REDUCES PERIOPERATTVE blood loss and transfusion requirements during cardiac surgery, but this antifibrinolytic serine protease inhibitor also has the potential to cause anaphylaxis during repeat exposure. The incidence of anaphylactic reactions to aprotinin reexposure has been reported to range between 1.2% and 2.8% in pediatric and adult cardiothoracic surgical patients, respectively. Notably, the incidence of aprotinin-induced hypersensitivity was higher (4.5%) in patients with a reexposure interval less than 6 months, and the majority (72%) of reported cases occurred within 3 months of the initial exposure. Several guidelines (published at the manufacturer's web site, www.trasylol.com) about the use of aprotinin in patients previously exposed to the drug have been proposed based on anecdotal observations. However, precise identification of patients who may be at greatest risk of developing anaphylaxis or those in whom aprotinin should be strictly avoided has proven to be very difficult, in part because aprotinin anaphylaxis during reexposure is a relatively unusual event.