Objectives:
1) Review the results from recent retrospective studies that have found an association between aprotinin and renal dysfunction after cardiac surgery.
2) Review the evidence supporting the use of aprotinin to decrease blood loss and transfusions in major orthopaedic surgery.
3) Learn some of the principles and limitations of multivariate analysis and propensity score.
Articles and Presenters:
1) Karkouti K, et al. A propensity score case-control comparison of aprotinin and tranexamic acid in high-transfusion-risk cardiac surgery. Transfusion 2006;46:327-38.
Presenter: Behrooz Yaghchi, MD, PGY-3. Presentation pending
2) Mangano DT. et al. The risk associated with aprotinin in cardiac surgery. N Engl J Med 2006;354:353-65.
Presenter: Jordan Cuthbert, MD, PGY-4 Presentation pending
3) Shiga T, et al. Aprotinin in major orthopedic surgery: a systematic review of randomized controlled trials. Anesth Analg 2005;101:1602-7.
Presenter: Kim Walton, MD, PGY-2 Presentation pending
The following articles provide additional information and points of view on this Journal Club topic:
i. Hiatt WR. Observational studies of drug safety: Aprotinin and the absence of transparency. N Engl J Med 355:2171-3 (letter).
ii. Hogue C, London MJ. Aprotinin use in cardiac surgery: anew or continuing controversy? Anesth Analg 2006;103:1067-70. (Editorial)
iii. Smith PK, Ashish SS. The role of aprotinin in a blod-conservatiom program. J Cardiothorac Vasc Anesth 2004;18:24S-28S.
iv. Kuitunen A, et al. The effects of aprotinin and tranexamic acid on thrombin generation and fibrinolytic response after cardiac surgery. Acta Anaesthesiol Scand 2005;49:1272-9.
The Journal Club is an accredited group learning activity, as defined in Section 1 of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.
