The Use of Aprotinin in Pediatric Patients: A Review

Perfusion Services, The Hospital for Sick Children, Toronto, Ontario, Canada

^* Address correspondence to: Jennifer McDonough, Perfusion Services, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G1X8. Tel.: 416-813-6870; Fax: 416-813-6636; E-mail: jennifer.mcdonough@sickkids.ca

Received: 18 March 2002
Accepted: 6 June 2003

Abstract

This literature review includes all reports from 1993 to 2000 concerning the use of aprotinin in children undergoing cardiopulmonary bypass (CPB) for congenital cardiac surgery. This review examined a nonhomogeneous pediatric patient population ranging from neonates to children up to 18 years of age, presenting many challenges. There have been publications advocating its use and those that have found no significant difference between the control group and those receiving aprotinin. The literature suggests that there is improvement in postoperative blood loss in pediatric patients undergoing redo cardiac surgery, but no significant difference in blood loss in those undergoing primary surgical repair. There is some evidence in the neonatal study groups that with high-dose aprotinin the inflammatory response is attenuated, leading to a reduction in inotropic support, earlier extubation, a tendency toward reduced post-operative blood loss and a reduced hospital stay. In most of the studies, the actual dose of aprotinin has varied with “highdose aprotinin” demonstrating the most significant differences. To achieve an adequate dose of aprotinin, the dose must be calculated on either the patient’s weight or their body surface area, and must include an appropriate dose in the prime of the cardiopulmonary bypass circuit, to achieve a plasma concentration between 200 KIU/mL to 400 KIU/mL. The incidence of anaphylactic reactions reported in the literature range from 0.3 to 0.6%. To date, there is no evidence to indicate any contraindication related to the use of aprotinin in the pediatric population.