Aprotinin is a naturally occurring polybasic polypeptide serine protease inhibitor, purified from cattle lungs. It is used in cardiac surgical procedures. It decreases blood loss and transfusion requirements (30 to 40%) by its antifibrinolytic effect, platelet preservation, anti-inflammatory effect and possible preventive action on CNS injury.
0.5% of allergic reactions.
2.1% to 5.8% if re-exposure.
Between 1964 and 1993: 26 cases have been reported (3 deaths).
Interval of less than 200 days between two aprotinin exposures; especially 35 days to 2 months.
General: anaphylactic shock.
Cutaneous: localized or generalized urticaria.
Skin-prick tests, then intradermal skin tests from 1/1000 to 1/10: a few cases with positive skin tests after an allergic reaction.
Specific IgE and IgG
After 48 months, 50% of all patients still show measurable levels of IgG antiaprotinin.
IgE and IgG antiaprotinin are found in 55% of patients with allergic reactions and 32% of non-reactors. Thus, clinical value is not clearly established.
Non-specific histamine release.
Do not use aprotinin in non-cardiovascular surgery.
Delay the first bolus injection of aprotinin until the surgeon is ready to begin cardiopulmonary bypass.
Test dose of 10000 KIU of aprotinin in all patients with aprotinin treatment.
H1/H2 blockade (clemastine 0.03 mg/kg + cimetidine 5 mg/kg) in cases of known or possible previous exposure.
Avoidance of re-exposure within the first 6 months after the previous exposure to aprotinin.
Use predictive skin-tests in patients with previous exposure or beef-allergic.
Other antifibrinolytics are available (tranexamic acid).