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APROTININ IN FIBRIN ADHESIVES INDUCES IGE-RESPONSE

Scheule, Albertus M. MD; Beierlein, Wolfram MS; Wendel, Hans P. PhD; Heinemann, Markus K. MD; Eckstein, Friedrich S. MD; Ziemer, Gerhard MD

doi: 10.1097/00000539-199802001-00098
Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Cardiovascular Anesthesia
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Div. of Thoracic, Cardiac and Vascular Surgery, University of Tuebingen, Germany.

Abstract S98

Most commercially available fibrin adhesives contain aprotinin in doses of 3,000 KIU/ml. They are used in many surgical disciplines [1]. There is an elevated risk of hypersensitivity reactions at systemic reexposure to aprotinin [2]. Our aim was to examine the immunogenic potency of the substance as a content of fibrin adhesive.

METHODS: We investigated 49 children with congenital heart disease treated surgically. All patients received aprotinin only topically as contained in commercially available fibrin glue. Serum samples were drawn preoperatively, 1 week, 2 weeks, 6 weeks and approximately 1 year after surgery. They were analyzed for aprotinin-specific IgG antibodies employing a standard ELISA and a fluorescence enzyme immunoassay for aprotinin-specific IgE antibodies.

RESULTS: (Table 1)

Table 1

Table 1

The doses of aprotinin given did not differ significantly in antibody-negative and -positive patients, the median age of IgG-negative children was significantly lower (7.8 vs. 25.8 months, p < 0.05).

CONCLUSION: Our findings show the existence of a sub-group of patients developing aprotinin-specific IgG and IgE antibodies after topical application of aprotinin. If aprotinin use in any form is planned in a patient having received aprotinin as contained in commercially available fibrin adhesives, we propose prophylactic measures as monitoring, an intravenous line and pretreatment with antihistaminics to avoid unexpected anaphylactic reactions.

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REFERENCES

1. Thromb Haemost 1995; 74: 482-485.
2. J Thorac Cardiovasc Surg 1997; 113: 194-201.
© 1998 International Anesthesia Research Society