Aprotinin

What it is and how it works

Aprotinin is a polypeptide that inhibits serine proteases including plasmin, kallikrein and trypsin. By inhibiting fibrinolysis and the contact activation pathway it reduces blood loss and the systemic inflammatory response during cardiopulmonary bypass.

Indications

Prophylactic use to reduce blood loss and transfusion in adult patients at high risk of major blood loss undergoing isolated cardiopulmonary bypass graft surgery (coronary artery bypass grafting without other cardiovascular surgery).

Dosage and administration (summary)

Dosing is individualised by the anaesthetist/cardiac surgeon according to protocol, starting with a 1 mL intravenous test dose at least 10 minutes before the loading dose, followed by loading, pump-prime and continuous infusion doses.

Contraindications

Hypersensitivity to aprotinin; positive aprotinin-specific IgG test or exposure to aprotinin within the previous 12 months (increased anaphylaxis risk).

Warnings and precautions

Risk of anaphylactic reactions, highest on re-exposure; a test dose is mandatory and resuscitation facilities must be available. Possible increased risk of renal dysfunction; careful benefit–risk assessment is required. Requires adequate heparinisation, monitored with a method not affected by aprotinin (e.g. kaolin-activated ACT).

Pregnancy

Use only if clearly needed because data are limited.

Storage and supply

Store below 25 °C; do not freeze.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.