Aprotinin decreases the incidence of cognitive deficit following CABG and cardiopulmonary bypass: a pilot randomized controlled study.

Hdl Handle:
http://hdl.handle.net/10147/208937
Title:
Aprotinin decreases the incidence of cognitive deficit following CABG and cardiopulmonary bypass: a pilot randomized controlled study.
Authors:
Harmon, Dominic C; Ghori, Kamran G; Eustace, Nicholas P; O'Callaghan, Sheila J F; O'Donnell, Aonghus P; Shorten, George D
Affiliation:
Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, , Wilton Road, Cork, Ireland. dharmon@indigo.ie
Citation:
Can J Anaesth. 2004 Dec;51(10):1002-9.
Journal:
Canadian journal of anaesthesia = Journal canadien d'anesthesie
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/208937
DOI:
10.1007/BF03018488
PubMed ID:
15574551
Abstract:
PURPOSE: Cognitive deficit after coronary artery bypass surgery (CABG) has a high prevalence and is persistent. Meta-analysis of clinical trials demonstrates a decreased incidence of stroke after CABG when aprotinin is administrated perioperatively. We hypothesized that aprotinin administration would decrease the incidence of cognitive deficit after CABG. METHODS: Thirty-six ASA III-IV patients undergoing elective CABG were included in a prospective, randomized, single-blinded pilot study. Eighteen patients received aprotinin 2 x 10(6) KIU (loading dose), 2 x 10(6) KIU (added to circuit prime) and a continuous infusion of 5 x 10(5) KIU.hr(-1). A battery of cognitive tests was administered to patients and spouses (n = 18) the day before surgery, four days and six weeks postoperatively. RESULTS: Four days postoperatively new cognitive deficit (defined by a change in one or more cognitive domains using the Reliable Change Index method) was present in ten (58%) patients in the aprotinin group compared to 17 (94%) in the placebo group [95% confidence interval (CI) 0.10-0.62, P = 0.005); (P = 0.01)]. Six weeks postoperatively, four (23%) patients in the aprotinin group had cognitive deficit compared to ten (55%) in the placebo group (95% CI 0.80-0.16, P = 0.005); (P = 0.05). CONCLUSION: In this prospective pilot study, the incidence of cognitive deficit after CABG and cardiopulmonary bypass is decreased by the administration of high-dose aprotinin.
Language:
eng
MeSH:
Aprotinin/*therapeutic use; Cardiopulmonary Bypass/*adverse effects/methods/psychology; Cognition Disorders/etiology/*prevention & control/psychology; Coronary Artery Bypass/*adverse effects/methods/psychology; Dose-Response Relationship, Drug; Female; Hemostatics/*therapeutic use; Humans; Incidence; Male; Middle Aged; Neuropsychological Tests/statistics & numerical data; Pilot Projects; Postoperative Complications/etiology/prevention & control/psychology; Prospective Studies; Psychiatric Status Rating Scales/statistics & numerical data; Single-Blind Method; Time Factors
ISSN:
0832-610X (Print); 0832-610X (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorHarmon, Dominic Cen_GB
dc.contributor.authorGhori, Kamran Gen_GB
dc.contributor.authorEustace, Nicholas Pen_GB
dc.contributor.authorO'Callaghan, Sheila J Fen_GB
dc.contributor.authorO'Donnell, Aonghus Pen_GB
dc.contributor.authorShorten, George Den_GB
dc.date.accessioned2012-02-03T15:07:55Z-
dc.date.available2012-02-03T15:07:55Z-
dc.date.issued2012-02-03T15:07:55Z-
dc.identifier.citationCan J Anaesth. 2004 Dec;51(10):1002-9.en_GB
dc.identifier.issn0832-610X (Print)en_GB
dc.identifier.issn0832-610X (Linking)en_GB
dc.identifier.pmid15574551en_GB
dc.identifier.doi10.1007/BF03018488en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208937-
dc.description.abstractPURPOSE: Cognitive deficit after coronary artery bypass surgery (CABG) has a high prevalence and is persistent. Meta-analysis of clinical trials demonstrates a decreased incidence of stroke after CABG when aprotinin is administrated perioperatively. We hypothesized that aprotinin administration would decrease the incidence of cognitive deficit after CABG. METHODS: Thirty-six ASA III-IV patients undergoing elective CABG were included in a prospective, randomized, single-blinded pilot study. Eighteen patients received aprotinin 2 x 10(6) KIU (loading dose), 2 x 10(6) KIU (added to circuit prime) and a continuous infusion of 5 x 10(5) KIU.hr(-1). A battery of cognitive tests was administered to patients and spouses (n = 18) the day before surgery, four days and six weeks postoperatively. RESULTS: Four days postoperatively new cognitive deficit (defined by a change in one or more cognitive domains using the Reliable Change Index method) was present in ten (58%) patients in the aprotinin group compared to 17 (94%) in the placebo group [95% confidence interval (CI) 0.10-0.62, P = 0.005); (P = 0.01)]. Six weeks postoperatively, four (23%) patients in the aprotinin group had cognitive deficit compared to ten (55%) in the placebo group (95% CI 0.80-0.16, P = 0.005); (P = 0.05). CONCLUSION: In this prospective pilot study, the incidence of cognitive deficit after CABG and cardiopulmonary bypass is decreased by the administration of high-dose aprotinin.en_GB
dc.language.isoengen_GB
dc.subject.meshAprotinin/*therapeutic useen_GB
dc.subject.meshCardiopulmonary Bypass/*adverse effects/methods/psychologyen_GB
dc.subject.meshCognition Disorders/etiology/*prevention & control/psychologyen_GB
dc.subject.meshCoronary Artery Bypass/*adverse effects/methods/psychologyen_GB
dc.subject.meshDose-Response Relationship, Drugen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHemostatics/*therapeutic useen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIncidenceen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNeuropsychological Tests/statistics & numerical dataen_GB
dc.subject.meshPilot Projectsen_GB
dc.subject.meshPostoperative Complications/etiology/prevention & control/psychologyen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshPsychiatric Status Rating Scales/statistics & numerical dataen_GB
dc.subject.meshSingle-Blind Methoden_GB
dc.subject.meshTime Factorsen_GB
dc.titleAprotinin decreases the incidence of cognitive deficit following CABG and cardiopulmonary bypass: a pilot randomized controlled study.en_GB
dc.contributor.departmentDepartment of Anaesthesia and Intensive Care Medicine, Cork University Hospital, , Wilton Road, Cork, Ireland. dharmon@indigo.ieen_GB
dc.identifier.journalCanadian journal of anaesthesia = Journal canadien d'anesthesieen_GB
dc.description.provinceMunster-
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