Pharmacology of Aprotinin and Efficacy During Cardiopulmonary Bypass

Aprotinin (Trasylol, Bayer AG, Leverkusen, F.R.G.) is a broad-based proteinase inhibitor isolated from bovine lung (85). It is a polypeptide with a molecular weight of 6,000 (6) and consists of 16 different amino acids arranged in a chain with 58 members (5). Aprotinin was first introduced for clinical use in 1953 by Frey (26) for the treatment of acute pancreatitis. Since this beginning, the literature on the possible therapeutic uses of aprotinin in a wide variety of disease states has been extensively studied in animals and humans. Clinical indications for the therapeutic use of aprotinin that have been suggested include, but are not limited to, acute pancreatitis, septic shock, adult respiratory distress syndrome, hemorrhagic shock, multiple trauma, and acute myocardial infarction, and aprotinin has been used to stabilize the cardiovascular function following surgical procedures and to prevent fat emboli, as reviewed (3 1,36,37,44). Aprotinin has more recently been used to limit excessive bleeding during and following initial and reoperative open-heart surgery with cardiopulmonary bypass (14,20,68,82). In 1967, Haberland and Matis (37) stated that at that time more than 1,500 original papers had been published on the therapeutic use of aprotinin in a wide variety of fields. Since then, the number of publications concerning the therapeutic use of aprotinin in inflammatory disease states has continued to grow, mostly in Europe. Also, the indications for treatment with aprotinin have expanded, most recently to include open-heart surgery with cardiopulmonary bypass ( 14,20,68).