Classifications: coagulator, hemostatic, systemic; Therapeutic:hemostatic; antifibrinolytic
Prototype: Aminocaproic acid
Pregnancy Category: B
10,000 KIU/mL injection (one KIU equals 0.14 mg)
A proteolytic enzyme inhibitor of bovine origin. It inhibits protease by interaction with certain proteases; aprotinin has
antifibrinolytic effect, hemostatic stabilizing effect, and weak anticoagulant effect.
Aprotinin reduces postoperative bleeding in coronary bypass surgery patients by inhibiting fibrinolytic activity while preserving
platelet adhesive function and prolonging postoperative bleeding time.
Patients at increased risk of blood loss and blood transfusion during cardiopulmonary bypass in the course of repeat coronary
artery bypass surgery.
Hypersensitivity to aprotinin and bovine products.
Patients with heparinized blood; patients previously treated with aprotinin; renal impairment, renal failure, pregnancy
(category B). Safety and efficacy in children are not established.
Route & Dosage
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) Standard Regimen IV Loading Dose 2 million KIU over 2030 min; add 2 million KIU to the priming fluid of the cardiopulmonary priming pump; constant infusion of 500,000 KIU/h, continue until the patient leaves the OR Alternate Regimen IV Loading Dose 1 million KIU over 2030 min; 1 million into pump prime volume; 250,000 KIU/h while in OR
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 2030 min. Continuous: Follow with infusion at 50 mL/h (70 mg/h or 500,000 KIU/h). Use central venous catheter exclusively for aprotinin.
INCOMPATIBILITIES Solution/additive: amino acids, corticosteroids, fat emulsion, heparin, tetracyclines.
- Store at controlled room temperature.
Adverse Effects (≥1%)Body as a Whole:
Hypersensitivity reactions (rash, urticaria, anaphylaxis
Tachycardia, stroke, MI, congestive heart failure
Rash, urticaria. Urogenital: Nephrotoxicity
(elevated serum creatinine
). Other: Bronchospasm.
results in further prolongation of the whole blood activated clotting time (ACT).
Rapidly into extracellular fluid, then accumulates in proximal renal
tubular epithelial cells; crosses placenta; distributed
into breast milk. Metabolism:
Primarily in kidneys to small peptides or amino acids
By kidneys. Half-Life:
Initial 0.7 h, terminal 7 h.
Assessment & Drug Effects
- Monitor carefully for S&S of hypersensitivity during administration (see Appendix F). If hypersensitivity occurs, immediately
discontinue aprotinin and begin emergency treatment to prevent anaphylaxis.
- Monitor cardiac status and pulmonary function carefully during infusion. Patients with a history of hypersensitivity to
any allergens or who have previously received aprotinin are at special risk for hypersensitivity.
- Lab tests: After surgery, monitor aPTT, ACT, and cardiac, pulmonary, renal, and liver functions.