Personal Injury and Wrongful Death

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One of the primary concerns is the effect it appears to have on kidney function. Those concerns are summarized in a leading medical journal article that discusses the relationship between Trasylol and kidney damage (The Risk Associated with Aprotinin in Cardiac Surgery, Mangano DT, Tudor IC, Dietzel C; N Engl J Med 354:353, January 26, 2006):

Unlike lysine analogues, aprotinin has high affinity for the kidneys — a property that may explain our renal findings. After free glomerular passage, aprotinin binds selectively to the brush border of the proximal tubule membrane, and then, by pinocytosis, it enters into and accumulates within the cytoplasm, inhibiting tubule protease secretion (kallikrein and, secondarily, kinin), prostaglandin and renin synthesis, prostasin secretion, and bradykinin release. Under normothermic ischemia, hypothermia, and other states of high kallikrein activity, these untoward tubular effects are magnified and are complicated by dose-dependent renal afferent vasoconstriction; deep cortical and medullary perfusion and its autoregulation are thereby impaired, and focal tubular necrosis ensues. Furthermore, because of its interference with the synthesis and release of endothelial nitric acid, aprotinin also may instigate macrovascular or microvascular thrombosis.

Despite this in vitro and in vivo evidence, only a minority of the reports of 45 trials of aprotinin in surgical patients even comment on renal function, and of those trials, none were powered to discern renal failure, leaving earlier concerns unchecked. However, review of this evidence suggests the presence of several renal "safety signals," including aprotinin-associated alpha1-microglobulin production, tubule-cell deposition of protein bands and proteinuria, dose-dependent increases in creatinine, renal dysfunction, and platelet-fibrin thrombotic occlusions of the renal arterioles after death. Of note, even in a small study (involving 57 patients) that concluded that aprotinin was safe (albeit with concern regarding a possible type 1 statistical error), 90 percent suppression of urinary kallikrein excretion occurred, with arithmetic increases in sodium excretion and osmolar clearance.

Our data from approximately 1300 aprotinin-treated patients as compared with about 1300 control patients, then, clearly give credence to early concerns stemming from findings in animal models and preliminary findings in patients — namely, that aprotinin is associated with severe renal adverse events and that this association is dose-dependent. The lysine analogues, in contrast, are excreted nearly intact within 24 hours after intravenous administration, with their renal clearance approximating creatinine clearance. Moreover, few reports document an association between these agents and renal dysfunction — a renal-safety profile validated by our results.

The chief author of this study was quoted as saying that up to 1000 lives per month were lost as a result of this drug. In the case of death, a Trasylol lawsuit would include a wrongful death claim brought by the next of kin.

 

 

 


 


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