Aprotinin
Biochemistry
| Synonym | BPTI, Trasylol® |
|---|---|
| Molecular mass | 6.500 Da |
| Half-Life | 145 minutes |
The bovine Kunitz-type inhibitor aprotinin influences the intrinsic system of coagulation and fibrinolysis by inhibiting kallikrein. Apart from the main effect of aprotinin on kallikrein, further serine proteases such as trypsin, chymotrypsin and plasmin are inhibited. The bleeding complication reduction of aprotinin is to some extent also likely due to its inhibition of urokinase, APC and the factor VIIa-TF-complex.
Clinical significance
Aprotinin is applied in a dosage of 200 KIE/ml plasma especially in thorax surgery, to reduce intra- and post-operative blood loss and, therewith, transfusions. Its exact mechanism of action is as yet unknown. Apart from the retardation of fibrinolysis through the inhibition of kallikrein, an inhibition of platelet activation is being discussed.
Indication
Monitoring of the dosage during surgery
Literature
- Friberger P. Chromogenic peptide substrates. Their use for the assay of factors in the fibrinolytic and plasma kallikrein-kinin systems. J Clin Lab invest 42, Suppl 162, 84-85, 1982.
- Gallimore MJ, Fuhrer G, Heller W, Hoffmeister HE. Augmentation of kallikrein and plasmin inhibition capacity by aprotinin using a new assay to monitor therapy. In: Kinins V: Advances in Experimental Medicine and Biology 247b, 55-60, 1989.
- Chabbat J et al. Aprotinin is a competitive inhibitor of the factor VIIa-tissue factor complex. Thromb Res 71, 205-215, 1993.
- Christensen U, Schiødt J. Effects of aprotinin on coagulation and fibrinolysis enzymes. Fibr Proteol 11, 209-214, 1997.
- Cardigan RA et al. Determination of plasma aprotinin levels by functional and immunologic assays. Blood Coag Fibrinol 12, 37-42, 2001.
- Davis R, Whittington R. Aprotinin: A Review of its Pharmacology and Therapeutic Efficacy in Reducing Blood Loss Associated with Cardiac Surgery. Drugs 49, 954-983, 1995.
- Royston D. The current place of aprotinin in the management of bleeding. Anaesthesia. Jan 70 Suppl 1, 46-9, 2015.
- Walkden GJ, Verheyden V, Goudie R, Murphy GJ. Increased perioperative mortality following aprotinin withdrawal: a real-world analysis of blood management strategies in adult cardiac surgery. Intensive Care Med. Oct 39(10), 1808-17, 2013.