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Aprotinin Kidney Risk Varies by Type of Cardiac Surgery

Dysfunction risk elevated in patients who undergo off-pump surgery and take ACE inhibitors

FRIDAY, Feb. 8 (HealthDay News) -- The use of aprotinin during on-pump cardiac surgery appears to be safe, but its use during off-pump cardiac surgery in patients who take angiotensin-converting enzyme (ACE) inhibitors may be associated with a significantly increased risk of renal dysfunction, researchers report in the Feb. 9 issue of The Lancet.

Ronelle Mouton, of the Bristol Royal Infirmary in Bristol, U.K., and colleagues conducted a retrospective observational study of 9,106 patients who underwent on-pump or off-pump cardiac surgery between 2000 and 2007.

Among patients who underwent on-pump cardiac surgery, the researchers found virtually no difference in the increased risk of renal dysfunction associated with aprotinin and an ACE inhibitor (odds ratio 1.73) and aprotinin without an ACE inhibitor (OR, 1.81). Among patients who underwent off-pump surgery, however, the researchers found a more than doubled risk of renal dysfunction associated with aprotinin and an ACE inhibitor (OR, 2.87).

"Concerns about the possible association between aprotinin and post-operative renal dysfunction do not accord with evidence from published randomized controlled trials," the authors state. "We recommend that it might be beneficial for patients to discontinue any use of an ACE inhibitor before undergoing elective off-pump cardiac surgery, particularly patients with a history of renal impairment."

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