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39 Grocott HP, Sheng HX, Miura Y, SarrafYazdi S, Mackensen GB, Pearlstein RD, Warner DS. The effects of aprotinin on outcome from cerebral ischemia in the rat. Anesth Analg 1999; 88:1-7. This study determined whether aprotinin exhibits neuroprotective effects against either global or focal cerebral ischaemia in the rat. In this model aprotinin did not offer neuroprotection against cerebral ischaemia.
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42 Gott JP, Cooper WA, Schmidt FE, Brown WM, Wright CE, Merlino JD, et al. Modifying risk for extracorporeal circulation: trial of four antiinflammatory strategies. Ann Thorac Surg 1998; 66:747-753. Four state-of-the art anti-inflammatory strategies were studied in a prospective, randomized study comprising primary and reoperative cardiac surgery (n=400). Corticosteroids, aprotinin, leucocyte depletion, and heparin-bonded circuits were compared. Corticosteroids were given in all groups. These pharmacological and mechanical strategies attenuated the inflammatory response to CPB and translated into improved patient outcome. However, this response was not uniformly distributed, but rather was dependent on risk stratification.
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43 Wippermann CF, Schmid FX, Eberle B, Huth RG, Kampmann C, Schranz D, Oelert H. Reduced inotropic support after aprotinin therapy during pediatric cardiac operations. Ann Thorac Surg 1999; 67:173-176. The haemodynamic effects of perioperative aprotinin treatment were investigated in a randomized, double-blind, placebo-controlled trial in 34 infants. Twelve hours after CPB 10 patients in the placebo group and four in the aprotinin group had received enoximone (P < 0.05). The placebo group had received significantly larger doses of enoximone than the aprotinin group on arrival in the intensive care unit. The placebo group required significantly more inotropic support by enoximone than the aprotinin group to achieve an equal haemodynamic status.
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44 McCarthy RJ, Turnan KJ, O'Connor C, Ivankovich AD. Aprotinin pretreatment diminishes postischemic myocardial contractile dysfunction in dogs. Anesth Analg 1999; 89:1096-1100. This study has shown that aprotinin pretreatment diminishes postischaemic myocardial contractile dysfunction in dogs.
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46 Segal H, Sheikh S, Kallis P, Cottam S, Beard C, Potter D, et al. Complement activation during major surgery: the effect of extracorporeal circuits and high-dose aprotinin. J Cardiothorac Vasc Anesth 1998; 12:542-547. This study compared complement activation in patients undergoing thoracic surgery (n=8), open heart surgery (n=19) and liver transplantation (n=19). Complement activation during cardiac surgery occurred to a greater extent than during liver transplantation or thoracic surgery. This activation was not attenuated by aprotinin.
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47 Alderman EL, Levy JH, Rich JB, Nili M, Vidne B, Schaff H, et al. Analyses of coronary graft patency after aprotinin use: results from the International Multicenter Aprotinin Graft Patency Experience (IMAGE) trial. J Thorac Cardiovasc Surg 1998; 116:716-729. This study examined the effect of aprotinin on graft patency and perioperative myocardial infarction. This prospective, randomized, placebo-controlled, international, multicentre study showed varying results concerning graft patency, which overall occurred in 15.4% of the aprotinin-treated patients and in 10.9% of the control patients (P=0.03). The probability of vein graft occlusion was increased, but this outcome was promoted by multiple preoperative risk factors. Blood loss was reduced by aprotinin, and mortality and the occurrence of myocardial infarctions were equally distributed.
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48 Peters DC, Noble S. Aprotinin: an update of its pharmacology and therapeutic use in open heart surgery and coronary artery bypass surgery. Drugs 1999; 57:233-260. This is the latest overview of the aprotinin literature.
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