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

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    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
    Issue Date
    2012-02-03T15:07:55Z
    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
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    Citation
    Can J Anaesth. 2004 Dec;51(10):1002-9.
    Journal
    Canadian journal of anaesthesia = Journal canadien d'anesthesie
    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
    ISSN
    0832-610X (Print)
    0832-610X (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1007/BF03018488
    Scopus Count
    Collections
    Cork University Hospital

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