A comparison of the effect of aprotinin and ε-aminocaproic acid on renal function in children undergoing cardiac surgery

Galina Leyvi, Olivia Nelson, Adam S. Yedlin, Michelle Pasamba, Peter F. Belamarich, Singh R. Nair, Hillel W. Cohen

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: To assess the incidence of renal injury among pediatric patients who received aprotinin while undergoing cardiac surgery compared with those who received ε-aminocaproic acid (EACA). Design: A retrospective observational study. Setting: A single academic center. Participants: Pediatric cardiac patients who had cardiopulmonary bypass and received aprotinin or EACA. Intervention: Patients undergoing pediatric cardiac surgery received aprotinin from 2005 to 2007 and EACA from 2008 to 2009. Measurements and Main Results: The primary outcome was acute kidney injury (AKI) defined as serum Cr elevation at discharge more than 1.5 times the baseline value. Secondary outcomes included bleeding, blood transfusion, and the volume of chest tube drainage in the first 24 hours postoperatively. One hundred seventy-eight patients met inclusion criteria; 120 patients received aprotinin, and 58 patients received EACA. These 2 groups did not differ significantly in age, weight, or duration of cardiac bypass. Logistic regression analysis, adjusted for confounding variables (ie, baseline Cr, sex, age, CPB time, inotropic support and vasopressors), showed a higher odds of suffering AKI at discharge with the usage of aprotinin (odds ratio = 4.7; 95% confidence interval, 1.1-19.5; p = 0.03). The volume of the first 24 hours of chest tube drainage was not significantly different between groups, as well as packed red blood cells and cryoprecipitate units. However, fresh frozen plasma and platelets showed statistically significant differences with more transfusion in the EACA group. Conclusion: In this retrospective study, the authors observed a higher odds of AKI for aprotinin usage compared with EACA, suggesting that the known concern for adults with adverse kidney effects with aprotinin is also appropriate for pediatric patients.

Original languageEnglish (US)
Pages (from-to)402-406
Number of pages5
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume25
Issue number3
DOIs
StatePublished - Jun 2011

Fingerprint

Aminocaproic Acid
Aprotinin
Thoracic Surgery
Kidney
Acute Kidney Injury
Pediatrics
Chest Tubes
Drainage
Retrospective Studies
Confounding Factors (Epidemiology)
Blood Volume
Cardiopulmonary Bypass
Blood Transfusion
Observational Studies
Blood Platelets
Erythrocytes
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals

Keywords

  • acute kidney injury
  • antifibrinolytic agents
  • creatinine
  • pediatric cardiac surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

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title = "A comparison of the effect of aprotinin and ε-aminocaproic acid on renal function in children undergoing cardiac surgery",
abstract = "Objective: To assess the incidence of renal injury among pediatric patients who received aprotinin while undergoing cardiac surgery compared with those who received ε-aminocaproic acid (EACA). Design: A retrospective observational study. Setting: A single academic center. Participants: Pediatric cardiac patients who had cardiopulmonary bypass and received aprotinin or EACA. Intervention: Patients undergoing pediatric cardiac surgery received aprotinin from 2005 to 2007 and EACA from 2008 to 2009. Measurements and Main Results: The primary outcome was acute kidney injury (AKI) defined as serum Cr elevation at discharge more than 1.5 times the baseline value. Secondary outcomes included bleeding, blood transfusion, and the volume of chest tube drainage in the first 24 hours postoperatively. One hundred seventy-eight patients met inclusion criteria; 120 patients received aprotinin, and 58 patients received EACA. These 2 groups did not differ significantly in age, weight, or duration of cardiac bypass. Logistic regression analysis, adjusted for confounding variables (ie, baseline Cr, sex, age, CPB time, inotropic support and vasopressors), showed a higher odds of suffering AKI at discharge with the usage of aprotinin (odds ratio = 4.7; 95{\%} confidence interval, 1.1-19.5; p = 0.03). The volume of the first 24 hours of chest tube drainage was not significantly different between groups, as well as packed red blood cells and cryoprecipitate units. However, fresh frozen plasma and platelets showed statistically significant differences with more transfusion in the EACA group. Conclusion: In this retrospective study, the authors observed a higher odds of AKI for aprotinin usage compared with EACA, suggesting that the known concern for adults with adverse kidney effects with aprotinin is also appropriate for pediatric patients.",
keywords = "acute kidney injury, antifibrinolytic agents, creatinine, pediatric cardiac surgery",
author = "Galina Leyvi and Olivia Nelson and Yedlin, {Adam S.} and Michelle Pasamba and Belamarich, {Peter F.} and Nair, {Singh R.} and Cohen, {Hillel W.}",
year = "2011",
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T1 - A comparison of the effect of aprotinin and ε-aminocaproic acid on renal function in children undergoing cardiac surgery

AU - Leyvi, Galina

AU - Nelson, Olivia

AU - Yedlin, Adam S.

AU - Pasamba, Michelle

AU - Belamarich, Peter F.

AU - Nair, Singh R.

AU - Cohen, Hillel W.

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N2 - Objective: To assess the incidence of renal injury among pediatric patients who received aprotinin while undergoing cardiac surgery compared with those who received ε-aminocaproic acid (EACA). Design: A retrospective observational study. Setting: A single academic center. Participants: Pediatric cardiac patients who had cardiopulmonary bypass and received aprotinin or EACA. Intervention: Patients undergoing pediatric cardiac surgery received aprotinin from 2005 to 2007 and EACA from 2008 to 2009. Measurements and Main Results: The primary outcome was acute kidney injury (AKI) defined as serum Cr elevation at discharge more than 1.5 times the baseline value. Secondary outcomes included bleeding, blood transfusion, and the volume of chest tube drainage in the first 24 hours postoperatively. One hundred seventy-eight patients met inclusion criteria; 120 patients received aprotinin, and 58 patients received EACA. These 2 groups did not differ significantly in age, weight, or duration of cardiac bypass. Logistic regression analysis, adjusted for confounding variables (ie, baseline Cr, sex, age, CPB time, inotropic support and vasopressors), showed a higher odds of suffering AKI at discharge with the usage of aprotinin (odds ratio = 4.7; 95% confidence interval, 1.1-19.5; p = 0.03). The volume of the first 24 hours of chest tube drainage was not significantly different between groups, as well as packed red blood cells and cryoprecipitate units. However, fresh frozen plasma and platelets showed statistically significant differences with more transfusion in the EACA group. Conclusion: In this retrospective study, the authors observed a higher odds of AKI for aprotinin usage compared with EACA, suggesting that the known concern for adults with adverse kidney effects with aprotinin is also appropriate for pediatric patients.

AB - Objective: To assess the incidence of renal injury among pediatric patients who received aprotinin while undergoing cardiac surgery compared with those who received ε-aminocaproic acid (EACA). Design: A retrospective observational study. Setting: A single academic center. Participants: Pediatric cardiac patients who had cardiopulmonary bypass and received aprotinin or EACA. Intervention: Patients undergoing pediatric cardiac surgery received aprotinin from 2005 to 2007 and EACA from 2008 to 2009. Measurements and Main Results: The primary outcome was acute kidney injury (AKI) defined as serum Cr elevation at discharge more than 1.5 times the baseline value. Secondary outcomes included bleeding, blood transfusion, and the volume of chest tube drainage in the first 24 hours postoperatively. One hundred seventy-eight patients met inclusion criteria; 120 patients received aprotinin, and 58 patients received EACA. These 2 groups did not differ significantly in age, weight, or duration of cardiac bypass. Logistic regression analysis, adjusted for confounding variables (ie, baseline Cr, sex, age, CPB time, inotropic support and vasopressors), showed a higher odds of suffering AKI at discharge with the usage of aprotinin (odds ratio = 4.7; 95% confidence interval, 1.1-19.5; p = 0.03). The volume of the first 24 hours of chest tube drainage was not significantly different between groups, as well as packed red blood cells and cryoprecipitate units. However, fresh frozen plasma and platelets showed statistically significant differences with more transfusion in the EACA group. Conclusion: In this retrospective study, the authors observed a higher odds of AKI for aprotinin usage compared with EACA, suggesting that the known concern for adults with adverse kidney effects with aprotinin is also appropriate for pediatric patients.

KW - acute kidney injury

KW - antifibrinolytic agents

KW - creatinine

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