Faculty Collaboration Database

Safety of aprotinin use and re-use in pediatric cardiothoracic surgery. Circulation 2002 Sep 24;106(12 Suppl 1):I90-4

Date

10/02/2002

Pubmed ID

12354715

Scopus ID

2-s2.0-0037167647 (requires institutional sign-in at Scopus site)   45 Citations

Abstract

BACKGROUND: Hypersensitivity reactions to aprotinin have been reported in adult cardiac surgical patients undergoing initial and re-exposure to the medication. This study describes the incidence and impact of aprotinin hypersensitivity reactions in children undergoing cardiothoracic surgery.

METHODS AND RESULTS: In this retrospective review of our entire experience with aprotinin (n=865), 681 first exposures, 150 second exposures, and 34 third or higher exposures were examined. Reactions were classified as mild (generalized cutaneous erythema, Type A) or severe (unexplained cardiopulmonary instability after aprotinin exposure, Type B). Records of patients sustaining a reaction were reviewed to assess the impact of the reaction on outcome and to survey reaction management strategies. Reactions occurred in 7 of 681 first exposures (1.0%), of which 2 were Type A and 5 were Type B. In second exposures, there were reactions in 2 of 150 (1.3%), of which both were Type B. In 34 third or higher exposures, there was only 1 reaction (2.9%), which was Type B. Reactions were no more likely on second, third, or higher exposure than on initial exposure. Skin testing had a negative predictive value of 98.9% and a positive predictive value of 20%. Anti-aprotinin IgE was undetectable in 7 of 8 reactor cases tested. No adverse sequelae were attributed to aprotinin reaction.

CONCLUSIONS: The risk of hypersensitivity reactions to aprotinin is low in children undergoing cardiothoracic surgery, even with multiple exposures to the medication. Reactions are more likely with re-exposure, and risk increases with multiple exposures. Neither skin testing nor assays for IgE identified reactors.

Author List

Jaquiss RD, Ghanayem NS, Zacharisen MC, Mussatto KA, Tweddell JS, Litwin SB

Author

Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aprotinin
Cardiac Surgical Procedures
Child
Child, Preschool
Drug Hypersensitivity
Hemostatics
Humans
Immunoglobulin E
Infant
Infant, Newborn
Retrospective Studies
Skin Tests
Thoracic Surgical Procedures