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Ivashchenko AA, Zagribelnyy BA, Ivanenkov YA, Ivashchenko IA, Karapetian RN, Kravchenko DV, Savchuk NP, Yakubova EV, Ivachtchenko AV. The Efficacy of Aprotinin Combinations with Selected Antiviral Drugs in Mouse Models of Influenza Pneumonia and Coronavirus Infection Caused by SARS-CoV-2. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27154975. [PMID: 35956925 PMCID: PMC9370800 DOI: 10.3390/molecules27154975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
The efficacy of aprotinin combinations with selected antiviral-drugs treatment of influenza virus and coronavirus (SARS-CoV-2) infection was studied in mice models of influenza pneumonia and COVID-19. The high efficacy of the combinations in reducing virus titer in lungs and body weight loss and in increasing the survival rate were demonstrated. This preclinical study can be considered a confirmatory step before introducing the combinations into clinical assessment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alexandre V. Ivachtchenko
- ChemDiv Inc., San Diego, CA 92130, USA
- ASAVI LLC, 1835 E. Hallandale Beach Blvd, #442, Hallandale Beach, FL 33009, USA
- Correspondence: (R.N.K.); (A.V.I.)
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Janas-Naze A, Zhang W. Perioperative anaphylaxis to fibrin sealants in children with Noonan Syndrome: A retrospective study. Ann Allergy Asthma Immunol 2022; 129:95-100. [PMID: 35346879 DOI: 10.1016/j.anai.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 02/28/2022] [Accepted: 03/15/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND In the diagnosis of perioperative anaphylaxis, it is essential to define its cause to prevent future reexposures, especially in children with Noonan Syndrome who are characterized by a large number of systemic features and wide-ranging dysmorphia. From an oral surgeon's point of view, apart from an increased risk of tumor incidence, diverse hematologic anomalies are of high concern. OBJECTIVE Perioperative management of such patients often requires the use of fibrin sealants, which contain aprotinin. A certain number of anaphylaxis cases have been observed in our daily practice during such treatment, which was the reason for this evaluation. METHODS The study was conducted to retrospectively review perioperative anaphylaxis grade II and above in children with Noonan Syndrome who underwent surgeries in the Department of Oral Surgery, Medical University of Lodz, between 2006 and 2021. RESULTS Out of the 16 cases of suspected anaphylaxis to aprotinin, 14 were observed in children with Noonan Syndrome. The postoperative serologic screening revealed positive results for qualitative aprotinin-specific immunoglobulin (Ig) G, highly elevated quantitative aprotinin-specific IgG, and slightly elevated aprotinin-specific IgE antibodies. Interestingly, previous aprotinin administration or contact in the past 12 months was excluded. CONCLUSION Given that fibrin sealants are typically used in various surgical practices and although the anaphylaxis reactions in such cases are rare, it is essential to be cautious in patients with RASopathies who are at a high risk of developing anaphylaxis.
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Affiliation(s)
- Anna Janas-Naze
- Department of Oral Surgery, Medical University of Lodz, Lodz, Poland.
| | - Wei Zhang
- Shanxi Oral Disease Prevention and Treatment Center, Shanxi Provincial People's Hospital, Taiyuan, People's Republic of China
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Ivashchenko AA, Azarova VN, Egorova AN, Karapetian RN, Kravchenko DV, Krivonos NV, Loginov VG, Poyarkov SV, Merkulova EA, Rosinkova OS, Savchuk NP, Topr MA, Simakina EN, Yakubova EV, Ivachtchenko AV. Effect of Aprotinin and Avifavir ® Combination Therapy for Moderate COVID-19 Patients. Viruses 2021; 13:v13071253. [PMID: 34199134 PMCID: PMC8310315 DOI: 10.3390/v13071253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
COVID-19 is a contagious multisystem inflammatory disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied the efficacy of Aprotinin (nonspecific serine proteases inhibitor) in combination with Avifavir® or Hydroxychloroquine (HCQ) drugs, which are recommended by the Russian Ministry of Health for the treatment therapy of moderate COVID-19 patients. This prospective single-center study included participants with moderate COVID-19-related pneumonia, laboratory-confirmed SARS-CoV-2, and admitted to the hospitals. Patients received combinations of intravenous (IV) Aprotinin (1,000,000 KIU daily, 3 days) and HCQ (cohort 1), inhalation (inh) treatment with Aprotinin (625 KIU four times per day, 5 days) and HCQ (cohort 2) or IV Aprotinin (1,000,000 KIU daily for 5 days) and Avifavir (cohort 3). In cohorts 1–3, the combination therapy showed 100% efficacy in preventing the transfer of patients (n = 30) to the intensive care unit (ICU). The effect of the combination therapy in cohort 3 was the most prominent, and the median time to SARS-CoV-2 elimination was 3.5 days (IQR 3.0–4.0), normalization of the CRP concentration was 3.5 days (IQR 3–5), of the D-dimer concentration was 5 days (IQR 4 to 5); body temperature was 1 day (IQR 1–3), improvement in clinical status or discharge from the hospital was 5 days (IQR 5–5), and improvement in lung lesions of patients on 14 day was 100%.
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Affiliation(s)
| | - Valeria N. Azarova
- IPHARMA LLC, Skolkovo Innovative Centre, 121205 Moscow, Russia; (V.N.A.); (A.N.E.); (N.V.K.); (E.A.M.)
| | - Alina N. Egorova
- IPHARMA LLC, Skolkovo Innovative Centre, 121205 Moscow, Russia; (V.N.A.); (A.N.E.); (N.V.K.); (E.A.M.)
| | - Ruben N. Karapetian
- ChemRar Research Institute, 141401 Moscow, Russia
- Correspondence: ; Tel.: +7-(495)-925-30-74 (ext. 572)
| | - Dmitry V. Kravchenko
- Chemical Diversity Research Institute, 141401 Moscow, Russia; (D.V.K.); (N.P.S.)
| | - Natalia V. Krivonos
- IPHARMA LLC, Skolkovo Innovative Centre, 121205 Moscow, Russia; (V.N.A.); (A.N.E.); (N.V.K.); (E.A.M.)
| | | | - Stanislav V. Poyarkov
- Centre for Strategic Planning of the Federal Medical-Biological Agency (FMBA), 119121 Moscow, Russia;
| | - Elena A. Merkulova
- IPHARMA LLC, Skolkovo Innovative Centre, 121205 Moscow, Russia; (V.N.A.); (A.N.E.); (N.V.K.); (E.A.M.)
| | - Olga S. Rosinkova
- Clinical Hospital No. 1, 214006 Smolensk, Russia; (O.S.R.); (E.N.S.)
| | - Nikolay P. Savchuk
- Chemical Diversity Research Institute, 141401 Moscow, Russia; (D.V.K.); (N.P.S.)
| | | | - Elena N. Simakina
- Clinical Hospital No. 1, 214006 Smolensk, Russia; (O.S.R.); (E.N.S.)
| | | | - Alexandre V. Ivachtchenko
- ChemRar High-Tech Center, 141401 Moscow, Russia; (A.A.I.); (A.V.I.)
- Chromis LLC, Skolkovo Innovative Centre, 121205 Moscow, Russia;
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Fibrin glue as a local drug-delivery system for bacteriophage PA5. Sci Rep 2019; 9:2091. [PMID: 30765740 PMCID: PMC6376040 DOI: 10.1038/s41598-018-38318-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/06/2018] [Indexed: 01/25/2023] Open
Abstract
Fibrin glue has been used clinically for decades in a wide variety of surgical specialties and is now being investigated as a medium for local, prolonged drug delivery. Effective local delivery of antibacterial substances is important perioperatively in patients with implanted medical devices or postoperatively for deep wounds. However, prolonged local application of antibiotics is often not possible or simply inadequate. Biofilm formation and antibiotic resistance are also major obstacles to antibacterial therapy. In this paper we test the biocompatibility of bacteriophages incorporated within fibrin glue, track the release of bacteriophages from fibrin scaffolds, and measure the antibacterial activity of released bacteriophages. Fibrin glue polymerized in the presence of the PA5 bacteriophage released high titers of bacteriophages during 11 days of incubation in liquid medium. Released PA5 bacteriophages were effective in killing Pseudomonas aeruginosa PA01. Overall, our results show that fibrin glue can be used for sustained delivery of bacteriophages and this strategy holds promise for many antibacterial applications.
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Richmon JD, Tian Y, Husseman J, Davidson TM. Use of a Sprayed Fibrin Hemostatic Sealant after Laser Therapy for Hereditary Hemorrhagic Telangiectasia Epistaxis. ACTA ACUST UNITED AC 2018; 21:187-91. [PMID: 17424877 DOI: 10.2500/ajr.2007.21.2969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) is a relatively common autosomal dominant condition. Epistaxis is a frequent manifestation, often occurring daily and requiring iron and blood transfusions. Surgery often is bloody and difficult. The aim of this study was to evaluate the effectiveness of a sprayed fibrin, hemostatic sealant in preventing postoperative epistaxis after laser treatment of nasal mucosa in HHT. Fibrin sealant was compared with nasal packing for likelihood of postoperative epistaxis and financial impact including material costs and hospitalization fees. Methods Retrospective review was performed of 64 individual laser treatments for epistaxis in HHT patients at the University of California, San Diego, Medical Center between 2002 and 2005. Nasal packing was used in 30 procedures and fibrin sealant was used in 34 procedures. Results Six of 30 (20%) procedures using postoperative nasal packing required admission with an average hospital expense of $5914. One of 34 patients (3%) in the fibrin sealant group required hospitalization (p = 0.04). Conclusion Aerosolized fibrin sealant prevents postoperative epistaxis after nasal laser treatment in HHT patients. Compared with traditional nasal packing we found improved patient comfort and recovery with substantial cost savings.
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Affiliation(s)
- Jeremy D Richmon
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, USA
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Bracey A, Shander A, Aronson S, Boucher BA, Calcaterra D, Chu MW, Culbertson R, Jabr K, Kehlet H, Lattouf O, Malaisrie SC, Mazer CD, Oberhoffer MM, Ozawa S, Price T, Rosengart T, Spiess BD, Turchetti G. The Use of Topical Hemostatic Agents in Cardiothoracic Surgery. Ann Thorac Surg 2017; 104:353-360. [DOI: 10.1016/j.athoracsur.2017.01.096] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/27/2017] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Fibrin sealants are used for hemostasis and tissue adherence. AIM OF STUDY This systematic review summarizes published clinical data for fibrin sealant use in cardiovascular surgery. METHODS A literature search for the following terms was conducted using PubMed and EMBASE: (TISSEEL or Tissucol or Beriplast P or Evicel or Quixil or Crosseal or Reliseal or Fibringluraas or Bolheal or Tachosil or Vivostat or Vitagel or Artiss or "fibrin glue" or "fibrin sealant" or "fibrin tissue adhesive") and (cardiac or cardiovascular or vascular or heart or coronary or surgery). Case reports and series were excluded; although reports of controlled trials were preferred, uncontrolled trial data were also considered. RESULTS Clinical trials and chart review analyses of fibrin sealants were identified and summarized. Although clinical trial data were available for other agents, the majority of published studies examined TISSEEL. Overall, TISSEEL and other fibrin sealants showed improvements over standard of care or control groups for a variety of predefined endpoints. Safety findings are also summarized. CONCLUSIONS Data from these studies showed that fibrin sealants were well tolerated and provided effective hemostasis in a range of cardiac and aortic surgeries.
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Affiliation(s)
- John A Rousou
- Division of Cardiac Surgery, Baystate Medical Center, Springfield, Massachusetts 01107, USA.
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Cardillo G, Carleo F, Carbone L, De Massimi AR, Lococo A, Santini PF, Janni A, Gonfiotti A. Adverse effects of fibrin sealants in thoracic surgery: the safety of a new fibrin sealant: multicentre, randomized, controlled, clinical trial. Eur J Cardiothorac Surg 2011; 41:657-62. [PMID: 22219405 DOI: 10.1093/ejcts/ezr083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The safety of fibrin sealants (FS) has been questioned in the light of recent reports of adverse effects. We evaluated the safety of a new FS in a randomized controlled trial (RCT). METHODS Multicentre, open-label Phase II/III RCT to evaluate the safety of the new FS. The trial was approved by the Ethic Committee of each three participating Centre. FS includes two components (component 1: fibrinogen; component 2: thrombin), each of them subjected to two viral inactivation procedures. Out of 200 screened patients, 185 eligible patients (49 females, 136 males), aged between 18 and 75 years, undergoing major thoracic surgery were randomized to receive FS (#91 patients) as an adjuvant for air leak control or no treatment (#94 patients, control group). Safety variables were: percentage of subjects with adverse events associated with the therapy; formation of antibodies against bovine aprotinin; vital signs (blood pressure, body temperature, heart and respiratory rate); laboratory parameters. RESULTS Overall operative mortality was 3.2% (6/185), 1.1% in the FS group and 5.3% in the control group, respectively. Twenty patients (22%) had adverse events in the FS group and 22 (23.4%) in the control group. Atrial fibrillation (five patients in the FS group and four in the control group) and hyperpyrexia (five and seven patients, respectively, in the two groups) were the most common adverse events. No patient reported thromboembolic events (pulmonary embolism or deep vein thrombosis) during the in hospital stay or within 1 month from discharge. None of the adverse events was considered as treatment related. The formation of bovine aprotinin antibodies was reported in a total of 34 patients (37.4%) in the FS group and was not related to any adverse effect. CONCLUSIONS The present RCT did not show any increased risk of adverse events, and of surgical complications, related to the use of the new FS.
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Affiliation(s)
- Giuseppe Cardillo
- Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy.
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Gonfiotti A, Santini PF, Jaus M, Janni A, Lococo A, De Massimi AR, D'Agostino A, Carleo F, Di Martino M, Larocca V, Cardillo G. Safety and effectiveness of a new fibrin pleural air leak sealant: a multicenter, controlled, prospective, parallel-group, randomized clinical trial. Ann Thorac Surg 2011; 92:1217-24; discussion 1224-5. [PMID: 21958767 DOI: 10.1016/j.athoracsur.2011.05.104] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/19/2011] [Accepted: 05/27/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study evaluated the sealing capacity and safety of a new fibrin sealant (FS) to reduce alveolar air leaks (AALs) after pulmonary resections in a randomized controlled clinical trial conducted in 3 Italian centers. METHODS The study randomized (1:1) 185 patients with an intraoperative AAL graded 1 to 3 according to the Macchiarini scale: 91 received FS and 94 had standard lung closure. The primary outcomes were the length of postoperative AAL duration and the mean time to chest drain removal. Other end points included the percentage of patients without AAL, the development of serum antibodies against bovine aprotinin, and any adverse event related to FS. Chest drains were removed when fluid output was 100 mL/day or less, with no air leak. RESULTS The study groups were comparable with respect to demographic variables and surgical procedures. The FS group showed a statistically significant reduction in duration of postoperative AALs (9.52 vs 35.8 hours; p < 0.005) and in the percentage of patients with AALs at wound closure (81.11% vs 100%; p < 0.001); the difference in time to chest drain removal was not significant. Pleural empyema developed in 1 patient with FS treatment vs in 4 with standard treatment, and antibodies against bovine aprotinin were found in 34 of 91 FS-treated patients. CONCLUSIONS The present study showed that the new FS is safe and effective in preventing AALs after lung resections and in shortening the duration of postoperative AALs.
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Uibo R, Laidmäe I, Sawyer ES, Flanagan LA, Georges PC, Winer JP, Janmey PA. Soft materials to treat central nervous system injuries: evaluation of the suitability of non-mammalian fibrin gels. BIOCHIMICA ET BIOPHYSICA ACTA 2009; 1793:924-30. [PMID: 19344675 PMCID: PMC2895977 DOI: 10.1016/j.bbamcr.2009.01.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 01/06/2009] [Accepted: 01/07/2009] [Indexed: 12/24/2022]
Abstract
Polymeric scaffolds formed from synthetic or natural materials have many applications in tissue engineering and medicine, and multiple material properties need to be optimized for specific applications. Recent studies have emphasized the importance of the scaffolds' mechanical properties to support specific cellular responses in addition to considerations of biochemical interactions, material transport, immunogenicity, and other factors that determine biocompatibility. Fibrin gels formed from purified fibrinogen and thrombin, the final two reactants in the blood coagulation cascade, have long been shown to be effective in wound healing and supporting the growth of cells in vitro and in vivo. Fibrin, even without additional growth factors or other components has potential for use in neuronal wound healing in part because of its mechanical compliance that supports the growth of neurons without activation of glial proliferation. This review summarizes issues related to the use of fibrin gels in neuronal cell contexts, with an emphasis on issues of immunogenicity, and considers the potential advantages and disadvantages of fibrin prepared from non-mammalian sources.
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Affiliation(s)
- Raivo Uibo
- Immunology Group, IGMP University of Tartu, Ravila Street 19, Tartu 51014, Estonia
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Zoegall SG. New clinical perspectives from nurses on aprotinin and fibrin sealants. JOURNAL OF VASCULAR NURSING 2008; 26:100. [PMID: 19022167 DOI: 10.1016/j.jvn.2008.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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De Somer F, Delanghe J, Somers P, Debrouwere M, Van Nooten G. Mechanical and chemical characteristics of an autologous glue. J Biomed Mater Res A 2008; 86:1106-12. [DOI: 10.1002/jbm.a.31705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kober BJ, Scheule AM, Voth V, Deschner N, Schmid E, Ziemer G. Anaphylactic Reaction After Systemic Application of Aprotinin Triggered by Aprotinin-Containing Fibrin Sealant. Anesth Analg 2008; 107:406-9. [DOI: 10.1213/ane.0b013e31817e6043] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dietrich W, Ebell A, Busley R, Boulesteix AL. Aprotinin and anaphylaxis: analysis of 12,403 exposures to aprotinin in cardiac surgery. Ann Thorac Surg 2007; 84:1144-50. [PMID: 17888960 DOI: 10.1016/j.athoracsur.2007.05.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 05/03/2007] [Accepted: 05/04/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hypersensitivity reactions to the nonspecific proteinase inhibitor aprotinin may occur. The present study evaluates the incidence of hypersensitivity reactions to aprotinin. METHODS Data were prospectively collected as part of the institution's quality assurance program. The database was screened for anaphylactic reactions, especially those against aprotinin. The definition of an allergic reaction was predefined. A severe reaction was defined as hemodynamic instability of more than 10 minutes despite high dosages of vasopressors and inotropic medication. RESULTS Of 13,315 cardiac operations, 12,403 were done with aprotinin, with 801 reexposures in 697 patients. Eleven reactions to aprotinin (11 of 11,602; 0.09%, 95% confidence interval: 0.05% to 0.16%) were recorded after primary exposure, of which none was severe, while 12 reactions (12 of 801; 1.5%; 95% confidence interval: 0.86% to 2.6%) occurred after reexposure, of which 5 were severe. All severe reactions were in patients reexposed to aprotinin within 6 months after previous exposure. There was no reaction observed in patients reexposed to aprotinin within 3 days after the last exposure (n = 42). The incidence of hypersensitivity reactions was 4.1%, 1.9%, and 0.4% in the less than 6 months, 6 to 12 months, and more than 12 months reexposure intervals, respectively. CONCLUSIONS The risk of hypersensitivity reactions is low after primary exposure to aprotinin. This risk after reexposure reaches a maximum between the fourth day and the 30th day after previous exposure and declines considerably after 6 months. Consequently, application of aprotinin carries a high risk between the fourth and the 30th day after previous exposure, and cannot be recommended for the first 6 months, but is justifiable in previously aprotinin-exposed patients with a high risk of bleeding after this interval.
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Affiliation(s)
- Wulf Dietrich
- Department of Anesthesiology, German Heart Center Munich, Germany.
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Kaddoum RN, Chidiac EJ, Zestos MM, Rajan SD, Baraka A. An Anaphylactic Reaction After Primary Exposure to an Aprotinin Test Dose in a Child With a Severe Milk Allergy. J Cardiothorac Vasc Anesth 2007; 21:243-4. [PMID: 17418739 DOI: 10.1053/j.jvca.2006.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2006] [Indexed: 11/11/2022]
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Kheirabadi BS, Acheson EM, Deguzman R, Crissey JM, Delgado AV, Estep SJ, Holcomb JB. The Potential Utility of Fibrin Sealant Dressing in Repair of Vascular Injury in Swine. ACTA ACUST UNITED AC 2007; 62:94-103. [PMID: 17215739 DOI: 10.1097/01.ta.0000251595.45451.d0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A previous study in which fibrin sealant dressing (FSD) secured hemostasis in major arterial hemorrhage for 96 hours suggested the applicability of this dressing in damage control operations after severe trauma. The objective of this study was to determine the effective duration of FSD hemostatic function in vivo and to examine its potential utility for definitive repair of a major arterial injury in swine. METHODS High pressure bleeding in an infrarenal aortotomy was controlled by placing FSD on the wound with 4-minute compression (n = 15). If hemostasis was achieved, the abdominal cavity was closed. Surviving animals were killed at 2, 4, 6, and 8 weeks and aortotomy sites collected for histology. RESULTS FSD stopped arterial hemorrhage after 4-minute compression in 14 of 15 (93%) pigs. Dressings failed in two pigs at 36 and 53 minutes after treatment. Twelve (80%) animals recovered and resumed normal activities. Of the remaining 12, two developed rebleeding at the aortotomy site on days 8 and 11 and were killed; another was killed because of idiopathic low hematocrit on day 10. Nine pigs survived until scheduled to be killed, maintaining hemostasis with stable hematological values. In the surviving animals, serial computed tomography scans showed formation of a pseudoaneurysm at the aortotomy site, which resolved after 2 to 3 weeks. The initial vascular defect and pseudoaneurysm were filled with fibroblast-myoblast collagen rich tissues covered by endothelium. CONCLUSION FSD can seal an arterial injury, stop high pressure bleeding, and prevent rebleeding for at least 7 days. The dressing may be most beneficial in damage control operations. If combined with an elective interventional radiologic procedure (e.g. embolization or stenting), it may also offer an alternative to suture repair of vascular injuries in cases where profuse bleeding obstructs visualization.
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Affiliation(s)
- Bijan S Kheirabadi
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA.
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Richmon JD, Davidson TM. Pain Reduction by Fibrin Sealant in Older Children and Adult Tonsillectomy. Laryngoscope 2005; 115:1899; author reply 1900. [PMID: 16222220 DOI: 10.1097/01.mlg.0000177074.23962.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE To determine if transplanted corneal epithelial stem cells are safely and efficiently attached to the deficient limbal niche with use of fibrin sealant. The primary outcome is measured with respect to the stability of the transplant, with secondary qualitative evaluations of inflammation, patient comfort, speed of operation, and incidence of complications. METHODS This retrospective case study examined a total of 114 corneal stem cell reconstructions performed in 95 patients from 1996 to 2004 using corneal stem cells primarily, with a minority of amnion alone, or both. Fibrin sealant was used as the only technique of stem cell adhesion for limbal reconstruction for primary or recurrent pterygia and various stem cell-deficient diseases from 2000 to 2004. RESULTS The fibrin sealant group showed 1 small recurrence of pterygium but no complications. With sutures, there were 3 recurrences in the pterygia group. After completion of all surgical procedures, all patients were free of pterygia. Miscellaneous stem cell deficiencies were included to demonstrate that corneal stem cell transplants can be used in other corneal procedures in addition to pterygia. CONCLUSIONS Fibrin sealant alone effectively and safely attached corneal stem cell transplants to the limbal niche. The additional qualitative observations of a reduction in operation time, postoperative pain, and inflammation augurs for more extensive use of fibrin sealants in ophthalmology.
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Affiliation(s)
- Roswell R Pfister
- The Eye Research Foundation, Inc, Eye Research Laboratories, Birmingham, AL, USA.
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Jegoux F, Goyenvalle E, Bagot D'arc M, Aguado E, Daculsi G. In vivo biological performance of composites combining micro-macroporous biphasic calcium phosphate granules and fibrin sealant. Arch Orthop Trauma Surg 2005; 125:153-9. [PMID: 15761734 DOI: 10.1007/s00402-004-0748-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Fibrin glues are currently used by surgeons and can facilitate the handling of biomaterials. Combining fibrin glue with calcium phosphate bioceramics gives a mouldable composite that cements the granules into the implantation site. In addition to the mechanical aspect of the composite, it has been suggested that the mixture also promotes wound healing. These human blood derivatives contain natural (aprotinin) or synthetic (tranexamic acid) antifibrinolytic substances. We compared the bioactivity of two composites combining calcium phosphate granules with two different types of fibrin glue, one with aprotinin and the other with tranexamic acid. MATERIALS AND METHODS The composite was composed of fibrin glue (Tissucol) and 1 to 2 mm granules of biphasic calcium phosphate granules (MBCP) with a volume ratio of 1 for 2. Bone cavities were drilled in 12 New Zealand rabbits and filled with a composite with aprotinin-fibrin glue on the right condyle and one with tranexamic acid-fibrin glue on the left condyle. The rabbits were randomized into two groups: 3 and 6 weeks of delay. Light microscopy, scanning electron microscopy and image analysis were performed. RESULTS No adverse reactions were observed in either sample. Bony ingrowth associated with bioceramic resorption by osteoclastic TRAP-positive cells was noted. No significant difference was observed between the two composites. The bony ingrowth and ceramic resorption were qualitatively and quantitatively similar with both composites. CONCLUSION This study demonstrated that the choice of a natural (aprotinin) or synthetic (tranexamic acid) antifibrinolytic agent in the fibrin sealant associated with calcium phosphate granules and used as a bone substitute had no effect on the bioactivity of the composite. It remained efficient in bone reconstruction, no adverse effects were observed, and the bony ingrowth was qualitatively and quantitatively equivalent with the two types of fibrin sealant.
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Affiliation(s)
- Franck Jegoux
- EMI 99 03, Dental Surgery Faculty, INSERM Research Center on Materials of Biological Interest, Place A. Ricordeau, 44042 Nantes Cedex, France
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Affiliation(s)
- Ronald W Busuttil
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095-7054, USA
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22
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Hanson AJ, Quinn MT. Effect of fibrin sealant composition on human neutrophil chemotaxis. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2002; 61:474-81. [PMID: 12115473 DOI: 10.1002/jbm.10196] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The use of fibrin sealants offers one of the most physiologically compatible approaches to preventing postoperative adhesions. Although a number of fibrin sealant formulations have been developed, little is known about how the various components of these preparations affect the wound-healing process. Because one of the key steps in wound healing is the migration of phagocytic leukocytes, such as neutrophils, into the site of injury, we performed studies to characterize systematically the effects of various fibrin sealant components on neutrophil chemotaxis. Using a transwell chemotaxis assay, we found that increasing fibrin concentration resulted in an inhibition of the ability of the cells to migrate through the clots in a dose-dependent manner, and at fibrin clot concentrations >2.0 mg/mL chemotaxis was completely blocked. Factor XIII crosslinking of the clots also had a significant impact on neutrophil chemotaxis, and sealant preparations deficient in Factor XIII allowed neutrophil migration at much higher fibrin concentrations. The presence of various other fibrin sealant components such as plasminogen and fibrinolysis inhibitors (aprotinin and tranexamic acid) did not have any significant effects on the ability of neutrophils to migrate through fibrin clots as compared to control clots without these components. Overall, these studies show that the composition of fibrin sealant preparations can significantly affect neutrophil migration into the site of injury, which could possibly influence the wound healing process.
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Affiliation(s)
- Angela J Hanson
- Department of Veterinary Molecular Biology, Montana State University, Bozeman 59717, USA
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Pecquet C. [Risk factors for latex allergy. Diagnostic methods for aprotinin allergy]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21 Suppl 1:123s-128s. [PMID: 12091978 DOI: 10.1016/s0750-7658(02)00664-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C Pecquet
- Centre d'allergologie, hôpital Tenon, 4, rue de la Chine, 75970 Paris, France.
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Punjabi PP, Wyse RK, Taylor KM. Role of aprotinin in the management of patients during and after cardiac surgery. Expert Opin Pharmacother 2000; 1:1353-65. [PMID: 11249470 DOI: 10.1517/14656566.1.7.1353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Management of patients undergoing cardiac surgery has evolved in recent years as more is understood about the physiological changes and responses that occur during and after cardiopulmonary bypass (CPB). In particular, our understanding of the mechanisms involved in haemostasis and in the inflammatory response to bypass surgery, has allowed significant refinements in patient management. Improvements in the pharmacological conservation of blood loss have been striking, particularly with the development of the serine protease inhibitor, aprotinin (Trasylol, Bayer). Aprotinin represents a significant improvement, especially for patients at high risk, since it reduces the need for allogeneic and (sometimes scarce) blood products. However, in view of its cost, making an appropriate selection of patients most at risk of serious blood loss is a major consideration in the use of aprotinin. While its mechanisms of action are not well understood, the use of aprotinin also appears to reduce inflammatory response to CPB.
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Affiliation(s)
- P P Punjabi
- Department of Cardiothoracic Surgery, NHLI, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK.
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Kjaergard HK, Velada JL, Pedersen JH, Fleron H, Hollingsbee DA. Comparative kinetics of polymerisation of three fibrin sealants and influence on timing of tissue adhesion. Thromb Res 2000; 98:221-8. [PMID: 10713324 DOI: 10.1016/s0049-3848(99)00234-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The clinical performance of fibrin sealants may be influenced by physical properties such as elasticity, tensile strength, and ability to adhere to human tissue. These properties are related to the internal structure of the fibrin sealant that builds as it polymerises. Analysis of the minimum polymerisation time to achieve a functional fibrin clot is clinically important. Instant tissue-fibrin sealant adhesion is desirable to ensure that the fibrin sealant functions on contact and remains at the site of application without being washed away by blood or displaced by movement of the target tissue (e.g., the heart or lungs). The physical characteristics of fibrin sealants are related to the extent of fibrin cross-linking. Determination of the polymerisation rate allows calculation of the minimum time required to produce a functional clot. The adhesion characteristics to vital human tissue and kinetics of polymerisation between 20 and 300 seconds postapplication of Vivostat system patient-derived sealant have been analysed and compared to those obtained for two conventional fibrin sealants, Tissucol and Beriplast. Mathematical analysis of the experimental data revealed that polymerisation of Vivostat sealant followed first-order kinetics, whereas that of Beriplast and Tissucol followed second-order kinetics. This study demonstrates that Vivostat sealant polymerises faster than these other conventional fibrin sealants.
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Affiliation(s)
- H K Kjaergard
- Department of Cardiothoracic Surgery, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
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Scheule AM, Beierlein W, Arnold S, Eckstein FS, Albes JM, Ziemer G. The significance of preformed aprotinin-specific antibodies in cardiosurgical patients. Anesth Analg 2000; 90:262-6. [PMID: 10648304 DOI: 10.1097/00000539-200002000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Acute hypersensitivity reactions are serious complications of reexposure to aprotinin. Previous contact via infusions or fibrin tissue adhesives can induce specific antibodies. In this study, we aimed to elucidate the preoperative prevalence of aprotinin-specific antibodies in patients scheduled for cardiac operations. Sera of 520 consecutive cardiosurgical patients were collected preoperatively and screened retrospectively for aprotinin-specific IgG using a standard enzyme-linked immunosorbent assay (ELISA). Positive sera were analyzed also for aprotinin-specific IgA (ELISA) and IgE (fluorescence enzyme immunoassay). The histories of all patients were reviewed with focus on aprotinin preexposure. Of 520 patients, 22 (4%) had specific IgG. Only three of these had a documented aprotinin preexposure. Of 448 patients exposed to aprotinin intraoperatively, 15 had preformed specific antibodies. The only patient presenting with severe anaphylaxis was positive for both IgG and IgE, and had a recent IV preexposure in cardiovascular surgery. The presence of aprotinin-specific IgG alone seems not to induce adverse reactions on exposure. Exposure history alone is not sensitive enough to identify patients with aprotinin-specific antibodies. IMPLICATIONS Anaphylaxis on IV reexposure to aprotinin is a medical emergency. The clinical significance of preformed aprotinin-specific IgG remains questionable, whereas preformed IgE was present in the only patient who suffered from severe anaphylaxis on reexposure to aprotinin. Preformed antibodies are not reliably predicted by exposure history.
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Affiliation(s)
- A M Scheule
- Department of Surgery, Division of Thoracic, Cardiac, and Vascular Surgery, Tübingen University Hospital, Tübingen, Germany
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Scheule AM, Beierlein W, Arnold S, Eckstein FS, Albes JM, Ziemer G. The Significance of Preformed Aprotinin-Specific Antibodies in Cardiosurgical Patients. Anesth Analg 2000. [DOI: 10.1213/00000539-200002000-00005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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