Re: Heart-surgery drug risky, researchers find
- From: "Sue" <chrlie699@xxxxxxxxx>
- Date: 26 Jan 2006 16:40:33 -0800
Sue wrote:
> Roman Bystrianyk wrote:
> > Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San
> > Jose Mercury News, January 26, 2006,
> > Link:
> > http://www.mercurynews.com/mld/mercurynews/living/health/13715800.htm
> >
> > A drug widely used during heart surgery to control bleeding doubles the
> > risk of kidney damage, forcing an estimated 10,000 patients onto
> > dialysis each year, according to a new study from a group that is
> > calling for surgeons to abandon its use.
> >
> > Known as aprotinin, the drug also increases the risk of heart attack 48
> > percent, heart failure 109 percent and stroke 181 percent, according to
> > a study among nearly 4,400 patients reported today in the New England
> > Journal of Medicine.
> >
> > The researchers said the drug is not even needed in most cases because
> > there are two generic drugs that cost a tenth as much and are nearly as
> > good at stopping bleeding without increasing risks.
> >
> > ``I wonder how we can ethically prescribe aprotinin when there are
> > alternatives that are safer,'' said Dr. Dennis Mangano of the Ischemia
> > Research and Education Foundation, who led the study.
> >
> > The drug, which is derived from the lung tissue of cows, was approved
> > by the Food and Drug Administration in 1993. It is used in a
> > significant number of the 1 million heart surgeries performed worldwide
> > each year.
> >
> > An FDA official said the agency is aware of the study and is reviewing
> > the data.
> >
> > Bayer, which manufactures the drug and sells it under the brand name
> > Trasylol, said in a statement that it had not yet analyzed the study,
> > but that the results were not consistent with its own experience.
>
>
> It is my understanding that aprotinin is administered following CABG,
> in order to reverse the anticoagulant effects of heparin. Heparin (an
> anticoagulant) inhibits the conversion of prothrombin to thrombin, the
> step just preceding formation of fibrin and stable platelet clot
> formation.
>
> During CABG, fairly large cumulative doses of heparin are required to
> prevent clot formation.
>
> Since the on-pump procedure exposes the patient's blood to a plastic
> reservior, pump filters and much tubing, the body's clotting cascade,
> natural immune and inflammatory repsonses are activated. All of these
> reactions can result in red blood cell destruction and other
> complications.
>
> This is one reason why minimally invasive cardiac surgery "MICS"
> (off-pump) is generally favored over on-pump procedures,IMO (when
> indicated).
>
> Since the blood is not exposed to large surface areas of foreign
> material, MISCS eliminates the need for heparin administration.
> Therefore heparin reversal is not required, and the need for aprotonin
> (or other similar drug) is avoided as well!
>
> In addition, the body's natural yet undesirable responses (such as
> complement activation, cytokine activation, activation of coagulation
> factors etc.) are minimzed as well.
>
> Just some additional thoughts.
>
> -Sue (non doctor)
Please excuse my post. I was confusing protamine sulfate with
aprotinin. Protamine suflate is used to reverse heparin effects in
CABG procedures, not aprotonin.
Please strike all of my comments that indicate aprotonin. I was
referring to protamine sulfate.
My sincere apologies,
Sue (non doctor, thank goodness!)
.
- References:
- Heart-surgery drug risky, researchers find
- From: Roman Bystrianyk
- Re: Heart-surgery drug risky, researchers find
- From: Sue
- Heart-surgery drug risky, researchers find
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