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EFFIE L. GILLESPIE, PHARM.D., and KRISTEN A. GRYSKIEWICZ, PHARM.D., are Pharmacoeconomics and Outcomes Research Fellows, School of Pharmacy, University of Connecticut (UC), Storrs, and Department of Pharmacy Services, Hartford Hospital (HH), Hartford, CT. C. MICHAEL WHITE, PHARM.D., is Associate Professor of Pharmacy Practice, School of Pharmacy, UC, Storrs, and Co-Director, Cardiovascular Pharmacology and Arrhythmia Research, HH. JEFFREY KLUGER, M.D., is Director of Arrhythmia Service and Coronary Intensive Care Unit and Co-Director, Cardiovascular Pharmacology and Arrhythmia Research, HH, and Professor of Medicine, School of Medicine, UC, Farmington. CHESTER HUMPHREY, M.D., is Cardiothoracic Surgeon, Division of Thoracic Surgery, and SHERYL HOROWITZ, PH.D., is Statistician, Department of Research Administration, HH. CRAIG I. COLEMAN, PHARM.D., is Assistant Professor of Pharmacy Practice, School of Pharmacy, UC, Storrs, and Director, Pharmacoeconomics and Outcomes Studies Group, HH.

Address correspondence to Dr. Coleman at Hartford Hospital, 80 Seymour Street, CB 309, Hartford, CT 06102 (ccolema{at}harthosp.org).

Purpose. The relationship between adding aprotinin to standard care and the frequency of postoperative atrial fibrillation or flutter (POAF) in patients undergoing cardiothoracic surgery (CTS) with cardiopulmonary bypass (CPB) was studied. Methods. This was a retrospective cohort evaluation. All patients at a hospital who underwent CTS with CPB between October 1999 and October 2003 and who received aprotinin during surgery were included in the treatment group. Control patients were those who did not receive aprotinin; they were matched with treatment group patients for age, valvular surgery, history of atrial fibrillation or flutter, renal dysfunction, peripheral artery disease, smoking, angina, diabetes mellitus, congestive heart failure, previous CTS, sex, ß-blocker intolerance, and use of preoperative digoxin. The primary endpoint was POAF; secondary endpoints were perioperative transfusion use, length of stay (LOS), stroke, myocardial infarction, renal failure, graft occlusion, and death. Results. A total of 438 patients (219 per group) were evaluated. The patients’ mean age was 68 years, 67% were men, and 74% had had valvular surgery. Patients who received aprotinin (mean ± S.D. dose, 2.75 million ± 1.24 million kallikrein-inhibiting units) did not have a significantly lower frequency of POAF than control patients (28% versus 27%, respectively [p = 0.92]), nor was there a significant difference in secondary endpoints. Conclusion. Aprotinin therapy was not associated with a significant reduction in POAF in patients undergoing CTS with CPB. Perioperative transfusion use, LOS, stroke, myocardial infarction, renal failure, graft occlusion, and mortality also did not differ significantly between aprotinin and control groups. Index terms: Aprotinin; Atrial fibrillation; Atrial flutter; Blood; Cerebrovascular accident; Graft occlusion; Hemostatics; Hospitals; Kidney failure; Mortality; Myocardial infarction; Postoperative complications