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Trasylol (aprotinin)
Tradename: Trasylol. (voluntary marketing suspension, 2007) [2]
Indications:
- prevention or reduction in blood loss in high risk patients undergoing coronary artery bypass grafting (CABG)
a) open heart reoperation
b) pre-existing coagulopathy
c) religious beliefs that prohibit blood transfusions
Dosage:
1) test dose of 1 mL IV at least 10 minutes prior to loading dose
2) regimen 1
a) 280 mg (2 million units) IV over 20-30 minutes
b) 280 mg (2 million units) into pump prime volume
c) 70 mg/hr (500,000 units/hour) IV during operation
3) regimen 2
a) 140 mg (1 million units) IV over 20-30 minutes
b) 140 mg (2 million units) into pump prime volume
c) 35 mg/hr (250,000 units/hour) IV during operation
Injection: 1.4 mg/mL (10,000 units/mL) (100 & 200 mL).
Adverse effects:
1) not common (1-10%)
- atrial fibrillation, myocardial infarction [2], heart failure, atrial flutter, ventricular tachycardia, hypotension,fever, confusion, phlebitis, post-operative renal dysfunction [2,3], dyspnea, bronchoconstriction increased risk of death [2]
2) uncommon (< 1%)
- cerebral embolism, stroke [2], convulsion, hemolysis, hepatotoxicity, pulmonary edema, anaphylactic reactions more common with repeated administration
Test interactions:
1) prolongs whole blood clotting time of whole blood as determined by surface-activation methods
2) patients may require additional heparin even if aPTT appears to indicate adequate anticoagulation
General
aprotinin (Kunitz pancreatic trypsin inhibitor, kallikrein-trypsin inactivator)
References
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- FDA Medwatch
http://www.fda.gov/medwatch/safety/2006/safety06.htm#Trasylol
http://www.fda.gov/medwatch/safety/2007/safety07.htm#Aprotinin
- Mangano DT et el,
The risk associated with aprotinin in cardiac surgery
N Engl J Med 354:353, 2006
PMID: 16436767