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July 1991

The Medical Therapy of Hemorrhagic Complications Following Coronary Artery Bypass Grafting

Author Affiliations

Milan, Italy

Arch Intern Med. 1991;151(7):1458-1462. doi:10.1001/archinte.1991.00400070198035

To the Editor.—  We read with interest the excellent review article by Becker and Alpert1 in the October 1990 issue of the Archives. In our opinion, it might be useful that the readers of the Archives be provided with some data concerning aprotinin (Trasylol, Bayer AG, Leverkusen, Federal Republic of Germany), a drug available in most European countries and used for the treatment of hyperfibrinolytic hemorrhage and other indications, even though this drug is not registered in the United States.Aprotinin is a basic polypeptide, obtained from bovine lung. By forming reversible stoichiometric enzyme—inhibitor complexes, it acts as an inhibitor of human trypsin, plasmin, plasma, and tissue kallikrein. In 1987, Royston et al2 reported reduced blood loss and blood use in repeated coronary artery bypass grafting, due to the use of high doses of aprotinin (about 840 mg) during surgery. The decrease of postoperative bleeding was sufficient to ensure