Drug Functionality: For patients undergoing cardiopulmonary bypass in the course of coronary artery bypass graft, there is a high risk of perioperative blood loss and the need for blood transfusion. In order to reduce this risk, aprotinin is used. In other complicated surgeries as well like liver or heart or heart- lung transplantation or total hip replacement or peripheral vascular surgery, this medicine is used to reduce bleeding and the need of blood transfusion. Only preliminary studies have been done so far to assess the efficacy in these indicators and further studies are still to be carried out.

Forms of Trasylol: It is available in the form of clear, colorless, sterile isotonic solution for intravenous administration.

Dosage: Each milliliter contains 10,000 kallikrein inhibitor units and 9mg sodium chloride in water for injection. Hydrochloric acid or sodium chloride or both can be used to adjust the pH to 4.5- 6.5. Only central line should be used to administer all the intravenous doses of Trasylol. The medicine should be stored between 2˚C to 25˚C and should be prevented from freezing.

Uses:

  1. It is used to control bleeding in emergency cardiac operations especially if the patient has also been suffering from alteplase, streptokinase or urokinase. In such kind of medical cases, though aprotinin has proved helpful in preventing severe hemorrhage, however, controlled study to substantiate the same is pending.
  2. In pediatric cardiac surgeries, aprotinin has been less fruitful in controlling blood loss and the need for transfusions. In the case of pediatric use, the dosage and the dosing regimens had been very case specific; hence the conclusion of the efficacy of drug for this population could not be monitored.

Precautions:

  1. Trasylol’s initial drug should be administered first to assess the levels of exposure and the potentials of allergic reactions that can be caused due to the medicine. The initial dose should be given intravenously at least 10 minutes prior to the loading dose, that too, in an operative environment so that cardiopulmonary bypass can be easily initiated.
  2. The loading dose also has to be given intravenously in the supine position over a time span of 20- 30 minutes. In case the loading dose is administered rapidly, it may result in a transient fall in the blood pressure.
  3. Patients, who are already suffering from renal function disorders and planning to go for CABG, should outweigh the potential risks with the benefits, as aprotinin causes increase in serum creatinine values by more than 0.5mg/dL above baseline. So it can become all the more difficult for patients belonging to this population to bear the side effects caused due to administration of this drug.
  4. Trasylol has been rated as a Pregnancy Category B drug. Though limited reproduction studies on rats and rabbits have not revealed any signs of impaired fertility or any kind of harm to the unborn baby, still animal reproduction studies cannot always be a predictive of human response and hence Trasylol should be avoided during pregnancy only if otherwise stated.