aprotinin / Generic mfg. - LARVOL DELTA

Effectiveness and safety of antifibrinolytic agents in off-pump coronary artery bypass grafting: a systematic review and meta-analysis. (PubMed, Braz J Anesthesiol) - "In off-pump CABG, antifibrinolytics reduced the need for blood transfusion while reducing thromboembolic events and overall mortality in RCT subgroups, while pooled analyses combining RCTs and observational studies did not demonstrate significant reductions. PROSPERO LINK: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024545640."

Journal • Retrospective data • Review • Cardiovascular • Critical care

Human CELA1 has pancreatic elastase-like activity. (PubMed, Biochimie) - "We show that pro-hCELA1 cleavage by trypsin is blocked by aprotinin. We have determined the enzyme kinetics of the active fraction of recombinant hCELA1 and show that it follows steady-state kinetics with a higher substrate affinity than commercial porcine pancreatic elastase."

Journal • ELANE

HSP90α and KLK6 Co-Regulate Stress-Induced Prostate Cancer Cell Motility. (PubMed, bioRxiv) - "Screening for protease inhibitors that would rescue stress-induced decreases in MMP-2 activity identified a single serine protease inhibitor: aprotinin...We identify a novel stress-induced extracellular network that regulates MMP-2 activity and cell motility. We identified KLK6 as a stress-induced extracellular protease leading to decreased MMP-2 activity and cellular invasion, while eHSP90α is required for the rescue of MMP-2 activity once KLK6 is neutralized."

Journal • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • CDC37 • HSP90AA1 • KLK6 • MMP2

CLINICAL TRIAL WITH APROTININ IN THE ACUTE RESPIRATORY DISTRESS SYNDROME TREATMENT (clinicaltrials.gov) - P3 | N=156 | Not yet recruiting | Sponsor: Fundacion del Hospital Nacional de Paraplejicos para la Investigacion y la Integracion

New P3 trial • Acute Respiratory Distress Syndrome • Pulmonary Disease • Respiratory Diseases

Risks and Harms to Physicians Reporting Hematologic Adverse Drug Reactions (ADRs) to Health Authorities (ASH 2024) - "ADR findings resulted in drug removal (n = 7; Vioxx, Avandia, Bextra, Celebrex, Trasylol, Phenyl propanolamine, Hydroxy-ethyl starch), revised indications (n = 2) (Procrit, Aranesp 2007, 2008, 2010)) or 10-year delay in FDA-approval (n = 1) (Fereprox)...Pharmaceutical companies paid $600,000 (Fereprox) to $5.8 billion (Vioxx) in fines and settlements.Discussion : Twelve physicians experienced severe threats and/or harms after reporting hematologic-associated ADRs to Health Authorities and/or in major publications. We suggest physicians not sign secrecy agreements that might jeopardize public safety (as currently established by almost all US medical universities) and should partner with independent drug safety monitoring boards (DSMBs) on ADR evaluations to monitor safety concerns of drugs and medical devices."

Adverse drug reaction • Hematological Disorders • Oncology • Solid Tumor

Characterization of the enzymatic activities of cultured human fecal bacteria and their anti-Blastocystis effects (ASTMH 2025) - "Additionally, it was inhibited by PMSF, TLCK, aprotinin, benzamidine, and SBTI, which suggests that it belongs to the serine protease family...SEM analysis showed that most Blastocystis cells lost their integrity, suffered damage, and underwent perforation after 4 h of anaerobic incubation. This finding suggests that this protease may be a promising anti-Blastocystis natural alternative."

Gastrointestinal Disorder

Comparative Efficacy of Perioperative Blood Conservation Agents in Pediatric Cranial Vault Remodeling: A Systematic Review and Network Meta-Analysis. (PubMed, Neurosurgery) - "Our meta-analysis reveals that TXA + ACA reduce red blood cell transfusion rates and volumes, with TXA + EPO + iron and ACA + EPO being most effective. This highlights the superiority of combination therapies and underscores the need for structured multimodal protocols in perioperative blood conservation for pediatric CVR."

Journal • Retrospective data • Cardiovascular • Pediatrics

Towards Advanced Imaging of Cardiac Amyloidosis: Reassessing Aprotinin with 64 Cu Radiolabeling (EANM 2025) - "Although heat-based labeling is effective, it poses a risk of compromising protein structure and altering biological function, making laser labeling the more favorable method. Moreover, ⁶⁴Cu-labeled aprotinin would apply for PET/CT imaging offering superior diagnostic accuracy compared to early scintigraphis studies These findings are preliminary, and further refinement of reaction conditions could lead to improved outcomes."

Metastases • Amyloidosis • Cardiac Amyloidosis • Cardiomyopathy • Cardiovascular

HYPERCOAGULABLE PROFILE OF PREGNANT WOMEN WITH PREECLAMPSIA AND HYPOCOAGULABLE PROFILE OF THEIR OFFSPRING BASED ON ROTATIONAL THROMBOELASTOMETRY ASSESSMENT (FIGO 2025) - "This study evaluates the hemostatic profiles of PE women and their newborns through CCTs and ROTEM (Intrinsic-INTEM, Extrinsic-EXTEM, Fibrinogen-FIBTEM, and Aprotinin-APTEM)... CCTs for mothers and neonates do not consistently reflect hemostatic variations. PE women display a hypercoagulable state and heightened fibrinolysis compared to healthy controls, affecting clot initiation, amplification, and stability. Conversely, during the first hour of life, neonates from PE mothers exhibit a hypocoagulable profile compared to those from healthy mothers, with noted changes in amplification and propagation phases."

Clinical • Gynecology

Multiscale theoretical study of infrared spectroscopy for the thermal denaturation process of aprotinin. (PubMed, J Mol Model) - "After the simulation, the C = O stretching vibrations of peptide bonds were extracted from the trajectory files to calculate the autocorrelation function and third-order nonlinear response function, which were Fourier transformed to obtain the 1D and 2D IR spectra of aprotinin. The DSSP program in GROMACS was used to quantitatively analyze the secondary structure content of aprotinin at various temperatures, and the conformational changes under different temperature conditions were visually analyzed by using VMD software."

Journal

Therapeutic Potential of Tubular Serine Protease Inhibitors in Proteinuria. (PubMed, Am J Physiol Renal Physiol) - "Serine protease inhibitors, such as aprotinin, camostat mesylate, and nafamostat mesylate, as well as off-target effects of amiloride, have shown promise in preclinical and early clinical studies by mitigating these pathological processes. We identify key knowledge gaps, including the need for mechanistic pharmacodynamic trials, biomarker-guided patient selection using urinary serine protease activity, and long-term efficacy and safety studies. Serine protease inhibitors are a promising, underexplored therapeutic strategy in proteinuric conditions that may complement existing treatments by targeting specific pathogenic mechanisms involved in disease progression."

Journal • Chronic Kidney Disease • Fibrosis • Immunology • Inflammation • Nephrology • Renal Disease

Rotational Thromboelastometry (ROTEM) Hemostasis Profile in Pregnant Women with Preeclampsia and Their Offspring: An Observational Study. (PubMed, Diagnostics (Basel)) - "ROTEM (Intrinsic (INTEM), Extrinsic (EXTEM), Fibrinogen (FIBTEM), Aprotinin (APTEM)), and CCTs were performed...Several alterations were not reflected in CCTs. Further prospective studies should evaluate the role and clinical utility of combining ROTEM with CCTs for hemostatic monitoring in women with PE and their neonates."

Journal • Observational data • Cardiovascular • Gynecology • Hematological Disorders • Hypertension • Thrombocytopenia

A Case Description of Spontaneous Intracardiac Thrombogenesis During Mitral Valve Repair: A Complication of Aminocaproic Acid? (PubMed, A A Pract) - "Antifibrinolytic agents such as aprotinin and lysine analogs are used to mitigate hyperfibrinolysis. Although epsilon-aminocaproic acid (EACA) is generally considered safe, dosing regimens vary, and thrombotic complications are underreported in national registries. We describe a case of acute intracardiac thrombosis shortly after EACA administration during mitral valve repair in a patient with no known hematologic or hypercoagulable conditions. ."

Journal • Cardiovascular • Hematological Disorders • Inflammation • Thrombosis

Antifibrinolytics-aprotinin in cardiac surgery. (PubMed, Anaesth Intensive Care) - No abstract available

Journal • Cardiovascular

Half-dose versus full dose of aprotinin in cardiac surgery: a post-hoc analysis of the aprotinin European Registry. (PubMed, Eur J Cardiothorac Surg) - "Patients receiving the FD aprotinin regimen had less surgical re-exploration than those receiving the HD regimen. An increased risk of early postoperative AKI was observed in the FD group, mainly for patients with preoperative chronic kidney disease."

Journal • Retrospective data • Acute Kidney Injury • Cardiovascular • Chronic Kidney Disease • Nephrology • Renal Disease

Innovative strategies in coagulation management for cardiothoracic surgery: a narrative review of pharmacological and nonpharmacological approaches. (PubMed, J Cardiothorac Surg) - "The use of pharmacological interventions such as tranexamic acid, heparin, and aprotinin minimizes bleeding but increases the associated risks of renal impairment and seizures. Recent advancements in this context include novel hemostatic agents, prothrombin complex concentrates, and direct oral anticoagulants. Future research should not only explore the combined use of pharmacological and nonpharmacological strategies but also evaluate the long-term effects and cost-effectiveness of integrated approaches during cardiothoracic surgery, particularly in high-risk populations."

Journal • Review • CNS Disorders • Epilepsy • Hematological Disorders • Metabolic Disorders • Pediatrics • Renal Disease

Blood collection tubes with protease inhibitors to prevent falsely high renin concentrations due to cryoactivation. (PubMed, Clin Chim Acta) - "Our study shows more cryoactivation of renin in plasma aliquots stored at -20 °C compared to storage at + 4 °C. Cryoactivation of prorenin in trypsin inhibitor and protease inhibitor cocktail tubes was reversed by a 2-hours incubation at 37 °C, which may be an alternative procedure for laboratories that are not able to store renin samples in -80 °C freezers."

Journal

Variability in Oxytocin Blood Levels in Rats: A Review and Experimental Insights. (PubMed, Clin Psychopharmacol Neurosci) - "Furthermore, we investigated the effects of two anesthetic protocols (inhaled isoflurane and a combination of three anesthetics) and the proteinase inhibitor aprotinin on plasma oxytocin levels in adult male rats. Our findings revealed that neither the anesthetics nor aprotinin significantly affected plasma oxytocin levels. We also discussed potential factors contributing to the marked differences in reported rat blood oxytocin levels."

Journal • Preclinical • Anesthesia

A Comparative Study of the Efficacy and Safety Profile of Topical Application of Tranexamic Acid in the Form of Mist to Reduce Postoperative Bleeding in on-Pump CABG Procedures. (PubMed, Ann Card Anaesth) - "The topical application of TXA in mist form significantly reduced postoperative bleeding, the necessity for blood transfusion, and the duration of mechanical ventilation in on-pump CABG procedures."

Clinical • Journal • Cardiovascular

Rapid Clotting Assay for Tissue Factor Pathway inhibitor (TFPI) (ISTH 2025) - "A low amount of TF, cephalin, aprotinin and calcium trigger clotting, thus making the clotting time dependent on TFPI activity in the sample...Several samples from patients with thrombosis or a positive family history, and no abnormal results in other coagulation tests, showed abnormal TFPI activity. Ten out of 13 samples from patients with miscarriages, pregnancy thrombosis, or familiar thrombosis showed abnormal low TFPI activity, the remaining 3 had < 50% TFPI."

Cardiovascular • Hematological Disorders • Hemophilia • Hemophilia A • Rare Diseases • Thrombosis

Intraoperative Hemostatic Agents in Thoracic Aortic Surgery-A Scoping Review. (PubMed, J Clin Med) - "Two small RCTs-one on TXA, one on aprotinin-suggest reduced transfusions and blood loss. Small studies suggest potential for the routine use of antifibrinolytics, FEIBA, and fibrinogen supplementation-but only in bleeding patients with hypofibrinogenemia. High-quality RCTs focused on thoracic aortic procedures are needed to determine optimal coagulation management."

Journal • Review • Cardiovascular

The Effect of Prophylactic Use of Antifibrinolytics During Pediatric Non-Cardiac Surgeries on Bleeding and Transfusions: A Systematic Review and Meta-Analysis. (PubMed, Paediatr Anaesth) - "In craniofacial, scoliosis, and tonsillectomy/adenoidectomy surgery, prophylactic administration of tranexamic acid results in lower estimated blood loss. Tranexamic acid and aprotinin are effective for reducing transfusion in craniofacial surgery. For scoliosis surgery, tranexamic acid is more efficacious than aminocaproic acid. More literature is needed to assess the efficacy of tranexamic acid in VRDO/VRO and hip reconstruction surgery and the efficacy of different dosing regimens."

Journal • Retrospective data • Review • Cardiovascular • Pediatrics

Anaphylaxis associated with Tisseel fibrin sealant during re-resection of a craniopharyngioma: illustrative case. (PubMed, J Neurosurg Case Lessons) - "This case and the accompanied literature can aid in recognizing patients at risk for an anaphylactic reaction against aprotinin. It also serves to remind us that medicine used locally in the surgical field can also cause anaphylaxis. https://thejns.org/doi/10.3171/CASE2517."

Journal • Allergy • Brain Cancer • CNS Tumor • Dermatology • Hypotension • Immunology • Urticaria

Pharmacological alternatives to oxytetracycline as potential treatment of flexural limb deformities in foals: a preliminary in vitro cell viability and proliferation study. (PubMed, Sci Rep) - "The myofibroblasts were incubated with oxytetracycline, the MMP-inhibitors incyclinide, ilomastat, aprotinin, pentoxifylline, the lathyrogenic agent β-aminopropionitrile fumarate and Dulbecco's modified eagle medium as control. The morphology and immunohistochemistry profile of the cultured cells was consistent with tendon and ligament myofibroblasts. All test substances were biocompatible, shown by the absence of significant differences with cells incubated with medium, demonstrating the absence of cytotoxic or anti-proliferative effect on juvenile myofibroblasts in the tested concentrations in this preliminary study."

Journal • Preclinical

Neuroprotective Strategies in Coronary Artery Disease Interventions. (PubMed, J Cardiovasc Dev Dis) - "Pharmacological neuroprotection includes agents such as barbiturates, volatile anesthetics, lidocaine, NMDA receptor antagonists, magnesium, nimodipine, corticosteroids, and aprotinin. Postoperatively, timely antiplatelet administration, glucose control, hemodynamic stabilization, and cognitive monitoring are critical. Comprehensive neuroprotective approaches, spanning pre- to postoperative phases, aim to reduce neurological complications and enhance outcomes in coronary interventions."

Journal • Review • Anesthesia • Atherosclerosis • Cardiovascular • CNS Disorders • Coronary Artery Disease • Diabetes • Epilepsy • Hypertension • Ischemic stroke • Metabolic Disorders