1. The main role of aprotinin has been to prevent perioperative bleeding. High-dose aprotinin given during cardiopulmonary bypass procedures has been shown to reduce postoperative blood loss dramatically (Royston 1.990). In addition, aprotinin has been used to reduce blood loss in neurosurgery and in vascular, orthopedic, and urological surgery.

2. More recently, the same dose regimen of aprotinin has been used to arrest bleeding associated with prolonged extracorporeal CO 2 removal (B.r.u,n.ei...e,t.a.l 1992).

This effect may be utilized in patients with bleeding associated with any extracorporeal circulation, including hemofiltration and hemodialysis.

3. Life-threatening bleeding due to thrombolytic therapy may be arrested by the plasmin inactivation effect of aprotinin. Lower doses are required for this effect.

4. Blockade of the kallikrein-kinin system has been utilized in the management of shock states associated with pathological peripheral vasodilatation. High-dose aprotinin may improve hypotension and organ perfusion in septic shock and hepatic cirrhosis.

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