NAME OF DRUG
aprotinin

CLASSIFICATION

Hemostatic agent

ALTERNATE NAME

TRASYLOL

INDICATIONS

• restricted to patients undergoing CABG surgery who are at increased risk for blood loss and blood transfusion

RECONSTITUTION AND STABILITY

• available as 500,000 KIU/50 mL (70 mg/50 mL) vials
• stable at room temperature
• discard if solution is cloudy or contains particulate matter
• opened vials or diluted solutions should be used immediately

COMPATIBILITY

• compatible with NS, D5W
• incompatible with other medications

ROUTES OF ADMINISTRATION

administer via CENTRAL LINE only

• IV direct
  • maximum rate 50,000 KIU/minute (5mL/min)
• IV intermittent
  • maximum rate 50,000 KIU/minute (5 mL/min)
  • may be administered undiluted for further diluted in D5W or NS
• IV infusion

VH & HSC ADMINISTRATION POLICY

D - Direct IV route restricted to physicians only.

H - The IV infusion administration rate MUST be controlled by an automated infusion control device.

DOSAGE

Test dose recommended prior to administration:

• 10,000 KIU (1 mL) IV at least 10 minutes prior to initiation of full dosage.

Hemorrhage due to hyperfibrinolysis:

• Loading dose: 15,000-20,000 KIU/kg (up to 1,500,000 KIU) IV
• Maintenance dose: IV infusion of 50,000 KIU/hour (1 million KIU/day) until hemorrhage is arrested (up to 5 days of treatment)

Cardiothoracic Surgery:

• 10,000 KIU (1 mL) IV test dose, followed at least 10 minutes later by one of the following regimens:
  • “Half Hammersmith”: 1 million KIU (100 mL) over 20 minutes prior to skin incision, followed by a continuous infusion of 0.25 million KIU/hour (25 mL/hour) for the duration of the operation, with 1 million KIU (100 mL) added to the “pump prime”; OR
  • “Full Hammersmith”: 2 million KIU (200 mL) over 20 minutes prior to skin incision, followed by a continuous infusion of 0.50 million KIU/hour (50 mL/hour) for the duration of the operation, with 2 million KIU (200 mL) added to the “pump prime”

Orthotopic Liver Transplantation:

• 10,000 KIU (1 mL) test dose IV, followed at least 10 minutes later by a loading dose of 2 million KIU (200 mL) at induction of anesthesia, followed by an infusion of 500,000 KIU/hour (50 mL/hour)

500,000 KIU is equivalent to 70 mg

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• hypersensitivity reactions such as flushing, skin rash, tachycardia, bronchospasm, anaphylaxis, circulatory collapse and GI disturbances; more common on repeat exposure within 12 months after first exposure
• thrombophlebitis has occurred after aprotinin infusions

IMPORTANT IMPLICATIONS

• contraindicated in patients who have received aprotinin within the past 12 months
• may cause hypercoagulation effect which may predispose patient to small vessel and venous thrombosis
• may increase the risk of renal dysfunction and increase the need for dialysis in the peri-operative period; risk especially increased for patients with pre-existing renal impairment or those who receive aminoglycoside antibiotics or other drugs that alter renal function

Rev. Nov 2007