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Aprotinin

CARDIOVASCULAR SYSTEM

COAGULANTS - [ CARDIOVASCULAR SYSTEM ]

Aprotinin is a serine protease inhibitor (serpin) that inhibits fibrinolysis by free plasmin and may have other antihemorrhagic effects as well. It also inhibits the plasmin-streptokinase complex in patients who have received that thrombolytic agent. This drug was withdrawn from market in 2007 by FDA due to increased risk of mortality associated with renal failure, heart attack and stroke. (1)

Prophylactic use to reduce perioperative blood loss and the need for blood transfusion in patients undergoing cardiopulmonary bypass in the course of coronary artery bypass graft surgery who are at an increased risk for blood loss and blood transfusion (2)

Hypersensitivity to aprotinin (2)

Fatal anaphylactic reactions Fever, nausea and gastrointestinal disturbances Hypersensitivity reactions Skin rashes and eruptions, tachycardia, pallor or cyanosis, dyspnoea and anaphylactic shock (2)

Inhibition of the effects of fibrinolytic agents Captopril: Block the acute hypotensive effect of 100 mg captopril Heparin: Prolongation of activated clotting time (2)

Should be used during pregnancy only if clearly indicated Safety and effectiveness in pediatric patients have not been established Serum creatinine should be regularly monitored following administration of aprotinin (2)

Regimen A Initial test dose: 1.4 mg Loading dose: 280 mg Pump prime dose: 280 mg Constant infusion dose: 70 mg/hr Regimen B Initial test dose: 1.4 mg Loading dose: 140 mg Pump prime dose: 140 mg Constant infusion dose: 35 mg/hr (2)

1.Zehnder JL. Drugs used in disorders of coagulation. In: Katzung B, Masters S, Trevor A. Basic and Clinical Pharmacology. 12th ed. USA: McGraw Hill; 2012. P601-19. 2. Trasylol [Internet]. [cited 2013 September 13]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2006/020304s022lbl.pdf