Trasylol (aprotinin)

Introduction

Tradename: Trasylol. (voluntary marketing suspension, 2007)

Indications

• prevention or reduction in blood loss in high risk patients undergoing coronary artery bypass grafting (CABG)
  • open heart reoperation
  • pre-existing coagulopathy
  • religious beliefs that prohibit blood transfusions

Dosage

• test dose of 1 mL IV at least 10 minutes prior to loading dose
• regimen 1
  • 280 mg (2 million units) IV over 20-30 minutes
  • 280 mg (2 million units) into pump prime volume
  • 70 mg/hr (500,000 units/hour) IV during operation
• regimen 2
  • 140 mg (1 million units) IV over 20-30 minutes
  • 140 mg (2 million units) into pump prime volume
  • 35 mg/hr (250,000 units/hour) IV during operation

Injection: 1.4 mg/mL (10,000 units/mL) (100 & 200 mL).

Adverse effects

• not common (1-10%)
  • atrial fibrillation, myocardial infarction, heart failure, atrial flutter, ventricular tachycardia, hypotension,fever, confusion, phlebitis, post-operative renal dysfunction, dyspnea, bronchoconstriction increased risk of death
• uncommon (< 1%)
  • cerebral embolism, stroke, convulsion, hemolysis, hepatotoxicity, pulmonary edema, anaphylactic reactions more common with repeated administration

Test interactions

• prolongs whole blood clotting time of whole blood as determined by surface-activation methods
• patients may require additional heparin even if aPTT appears to indicate adequate anticoagulation

More general terms

• aprotinin