• P P Punjabi, R K Wyse, and K M Taylor.
• Department of Cardiothoracic Surgery, NHLI, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK. prakash@ppunjabi.com
• Expert Opin Pharmacother. 2000 Dec 1;1(7):1353-65.

AbstractManagement of patients undergoing cardiac surgery has evolved in recent years as more is understood about the physiological changes and responses that occur during and after cardiopulmonary bypass (CPB). In particular, our understanding of the mechanisms involved in haemostasis and in the inflammatory response to bypass surgery, has allowed significant refinements in patient management. Improvements in the pharmacological conservation of blood loss have been striking, particularly with the development of the serine protease inhibitor, aprotinin (Trasylol, Bayer). Aprotinin represents a significant improvement, especially for patients at high risk, since it reduces the need for allogeneic and (sometimes scarce) blood products. However, in view of its cost, making an appropriate selection of patients most at risk of serious blood loss is a major consideration in the use of aprotinin. While its mechanisms of action are not well understood, the use of aprotinin also appears to reduce inflammatory response to CPB.

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