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Aprotinin and coronary artery bypass surgery

Cerit, Levent

European Journal of Anaesthesiology (EJA): January 2018 - Volume 35 - Issue 1 - p 68–69
doi: 10.1097/EJA.0000000000000723

From the Department of Cardiology, Near East University, Nicosia, Cyprus

Correspondence to Levent Cerit, MD, Near East University Hospital, Near East Boulevard, Nicosia, Cyprus Tel: +903926751000; fax: +903926751000; e-mail:


Deloge et al.1 reported the results of the study ‘Aprotinin vs. tranexamic acid in isolated coronary artery bypass surgery: a large multicentre observational study’ where aprotinin significantly reduced 24-h blood loss compared with tranexamic acid. A significant decrease in the perioperative use of blood products, mainly related to intraoperative transfusions, was also observed in aprotinin-treated patients. The benefits of aprotinin should be considered when evaluating the risk of major blood loss and transfusion in patients scheduled for isolated coronary artery bypass surgery.1

The Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score has been validated as a bleeding risk predictor in patients with atrial fibrillation.2 There are some bleeding risk prediction scores, hepatic or renal disease, ethanol abuse, malignancy history, older (age > 75), reduced platelet count or function, rebleeding risk, hypertension (uncontrolled), anemia, genetic factors, excessive fall risk, stroke history (HEMORR2HAGES), AnTicoagulation and risk factors in atrial fibrillation (ATRIA) and HAS-BLED which are used in patients with atrial fibrillation. Among them, the HAS-BLED score predicts bleeding better than HEMORR2HAGES and ATRIA.3 HAS-BLED could predict the risk of bleeding and mortality in patients who underwent percutaneous coronary interventions independent of the presence of atrial fibrillation.4 Also, the HAS-BLED score had a high reliability in discriminating the risk of intracranial haemorrhage in study participants without atrial fibrillation.5

When considering that the HAS-BLED score has a predictive effect on bleeding and mortality in patients with percutaneous coronary interventions independent of atrial fibrillation, the evaluation of patients classified according to the HAS-BLED score (high ≥3, low 0 to 2) and the effect of aprotinin on haemorrhage, thrombotic complications and death may be useful.

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Acknowledgement related to this article

Assistance with the letter: none.

Financial support and sponsorship: none.

Conflicts of interest: none.

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1. Deloge E, Amour J, Provenchère S, et al. Aprotinin vs. tranexamic acid in isolated coronary artery bypass surgery: a multicentre observational study. Eur J Anaesthesiol 2017; 34:280–287.
2. Lip GY, Frison L, Halperin JL, et al. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol 2011; 57:173–180.
3. Apostolakis S, Lane DA, Guo Y, et al. Performance of the HEMORR(2)HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS (evaluating the use of SR34006 compared to warfarin or acenocoumarol in patients with atrial fibrillation) study. J Am Coll Cardiol 2012; 60:861–867.
4. Konishi H, Miyauchi K, Tsuboi S, et al. Impact of the HAS-BLED score on long-term outcomes after percutaneous coronary intervention. Am J Cardiol 2015; 116:527–531.
5. Lip GY, Lin HJ, Hsu HC, et al. Comparative assessment of the HAS-BLED score with other published bleeding risk scoring schemes, for intracranial haemorrhage risk in a non-atrial fibrillation population: the Chin-Shan Community Cohort Study. Int J Cardiol 2013; 168:1832–1836.
© 2018 European Society of Anaesthesiology