APROTININ
(a-pro-ti'nin)
Trasylol
Classifications: blood formers, coagulators, and anticoagulants; hemostatic
Prototype: Aminocaproic acid
Pregnancy Category: B

Availability

10,000 KIU/mL injection (one KIU equals 0.14 mg)

Actions

Polypeptide of bovine origin that inhibits protease. By interaction with certain proteases, aprotinin has antifibrinolytic effect, hemostatic stabilizing effect, and weak anticoagulant effect.

Therapeutic Effects

Aprotinin reduces postoperative bleeding in coronary bypass surgery patients by inhibiting fibrinolytic activity while preserving platelet adhesive function and prolonging postoperative bleeding time.

Uses

Prophylactically to reduce perioperative blood loss and need for blood transfusions during cardiopulmonary bypass in the course of repeat coronary artery bypass surgery. May also be used in selected cases of primary coronary artery bypass graft surgery where the risk of bleeding is especially high (i.e., impaired hemostasis, coagulopathy).

Contraindications

Hypersensitivity to aprotinin and bovine products.

Cautious Use

Patients with heparinized blood; patients previously treated with aprotinin; pregnancy (category B). Safety and efficacy in children are not established.

Route & Dosage

Cardiac Surgery
Adult: IV Test Dose 1-mL (10,000 kallikrein inactivator units [KIU]) given at least 10 min prior to loading dose (observe for signs of an allergic reaction) IV Loading Dose 2 million KIU over 20–30 min after induction of anesthesia, but prior to sternotomy, add 2 million KIU to the priming fluid of the cardiopulmonary priming pump IV Maintenance Dose Constant infusion of 500,000 KIU/h, continue until the patient leaves the OR

Administration

Intravenous

PREPARE: IV Test Dose/Loading Dose: Use as supplied (1 mL = 1.4 mg or 10,000 KIU) without further dilution.  

ADMINISTER: IV Test Dose: Give direct IV push over 1 min.  IV Loading Dose: Give over 20–30 min.  Continuous: Follow with infusion at 50 mL/h. Use central venous catheter exclusively for aprotinin.  

INCOMPATIBILITIES Solution/additive: amino acids, corticosteroids, fat emulsion, heparin, tetracyclines.

Adverse Effects (1%)

Body as a Whole: Hypersensitivity reactions (rash, urticaria, anaphylaxis). CV: Tachycardia. Hematologic: Thromboembolism. Skin: Rash, urticaria. Urogenital: Nephrotoxicity (elevated serum creatinine). Other: Bronchospasm.

Interactions

Drug: Heparin results in further prolongation of the whole blood activated clotting time (ACT).

Pharmacokinetics

Distribution: Rapidly distributes into the extracellular fluid, then accumulates in proximal renal tubular epithelial cells; crosses placenta; distributed into breast milk. Metabolism: Metabolized primarily in kidneys to small peptides or amino acids. Elimination: Excreted by kidneys. Half-Life: Initial 0.7 h, terminal 7 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug