Intended for patients receiving aprotinin treatment

What is coronary artery bypass graft surgery (CABG)?

The coronary arteries are the blood vessels that deliver oxygen-rich blood to the heart. If these arteries become restricted or blocked, you may experience chest pain (angina) or, in time, a heart attack.1

A CABG procedure is performed to relieve chest pain. Successful CABG can improve your course of the disease (prognosis) and provide a better quality of life by lessening pain and disability related to angina.1,2

During the procedure, your surgeon will graft a blood vessel between the aorta (the main blood vessel leaving the heart) and a point along the coronary artery, bypassing the obstructed vessel.2 Donor vessels for the graft can be taken from your leg, inside your chest, or your arm.2 The number of blood vessels grafted will depend on many of your coronary blood vessels have become narrowed or obstructed.3

Your heart will be temporarily stopped using medication while your surgeon performs the bypass surgery, and you may be supported by a heart–lung bypass machine.3 After the grafts have been attached, your heart will be restarted with electrical pulses.3

CABG illustration

Reprinted with permission from The Society of Thoracic Surgeons: ctsurgerypatients.org.

During a CABG, your surgeon will bypass an obstructed vessel in order to allow greater blood flow and relief from chest pain3

Aprotinin: understanding the medication that can be used in your operation

Aprotinin is a medication used to help reduce blood loss in patients undergoing heart surgery. Aprotinin is licensed in adults undergoing isolated coronary artery bypass graft surgery (CABG).4

After careful consideration of the risks and benefits, your doctor or surgeon has recommended that you would benefit from this treatment because you are at increased risk of major blood loss during your heart surgery.

What is aprotinin and how does it work?

Aprotinin minimises blood loss during and after your surgery, to reduce the risk of complications, including:

  • The need for blood transfusions, which are associated with poorer outcomes post-surgery5
  • The need to return to surgery, which can increase the risk of infection and delay your recovery, lengthening the duration of your hospitalisation

How will you be given aprotinin?

Aprotinin is given into a large blood vessel (intravenously) during your operation.4 The surgical team will monitor the effect of aprotinin throughout your surgery.

Are there any side effects of using aprotinin?

Like all medicines, this medicine can cause side effects, although not everybody gets them. Although allergic reactions are rare in patients receiving an aprotinin-containing medicinal product for the first time, patients who are given aprotinin more than once may have an increased chance of an allergic reaction. The symptoms of an allergic reaction may include:

  • Breathing difficulties
  • Blood pressure
  • Itching, rash and hives
  • Feeling sick

If any of these occur during administration of aprotinin your doctor/surgeon will stop treatment with the drug. Other side effects are:4

Uncommon: may affect up to 1 in 100 patients
  • Chest pain (myocardial ischaemia, coronary occlusion / thrombosis), heart attack (myocardial infarction)
  • Leakage of heart fluid into the surrounding body cavity (pericardial effusion)
  • Blood clot (thrombosis)
  • Kidney disease (acute renal failure, renal tubular necrosis)
  • Passing less urine than is normal
Rare: may affect up to 1 in 1,000 patients
  • Blood clot in blood vessels (arteries)
  • Severe allergic reaction (anaphylactic / anaphylactoid reaction)
Very rare: may affect up to 1 in 10,000 patients
  • Swelling on or around the location of the injected skin (injection and infusion site reactions, infusion site (thrombo- phlebitis)
  • Blood clot in the lungs (pulmonary embolism)
  • Severe blood clotting disorder that results in tissue damage and bleeding (disseminated intravascular coagulation)
  • Inability of the blood to clot or coagulate normally (coagulopathy)
  • Severe allergic shock (anaphylactic shock), which is potentially life threatening

How can I find out more about aprotinin?

There is a leaflet for patients included in the pack. It contains more information about the medicine. You can find a copy here. If you have any further questions or concerns, please speak to your doctor, surgeon, or pharmacist.

References

  1. NHS Overview: Coronary Artery Bypass Graft. Available from: https://www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/ Accessed August 2020
  2. British Heart Foundation Coronary bypass surgery. Available from: https://www.bhf.org.uk/informationsupport/treatments/coronary-bypass-surgery Accessed August 2020
  3. NHS How it’s performed: Coronary artery bypass graft: Available from: https://www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/what-happens/ Accessed August 2020.
  4. Aprotinin 10,000 KIU/ml Injection BP Summary of Product Characteristics. Available from: https://www.medicines.org.uk/emc/product/2472/smpc. Accessed December 2020.
  5. Koch CG et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006;34:1608–1616.