title: Reduction in blood loss and blood use after cardiopulmonary bypass with high-dose aprotinin versus autologous fresh whole blood transfusion.
abstract: Ninety patients undergoing cardiac surgery were randomly divided into three groups of 30 patients to compare the effects on bleeding and transfusion requirements of either intraoperative infusion of high-dose aprotinin (GpI) or reinfusion of autologous fresh whole blood (GpII) versus a control group (GpIII). Standardized anesthetic, perfusion, and surgical techniques were used. Platelet counts, hemoglobin concentration, hematocrit, fibrinogen, and Ivy-Nelson bleeding times determined at fixed times perioperatively did not differ among the three groups. The total loss from the chest drains was significantly reduced in GpI (328 +/- 28 mL; mean +/- SEM) as compared with the loss in GpII and GpIII (775 +/- 75 mL and 834 +/- 68 mL, respectively). There was a threefold difference in the total hemoglobin loss (GpI, 14.2 +/- 1.7 g; GpII, 50.1 +/- 5.0 g; GpIII, 45.0 +/- 5.2 g). GpI patients also received less banked blood: 250 +/- 53 mL versus 507 +/- 95 mL in GpII and 557 +/- 75 mL in GpIII. No GpI patient required transfusion of platelets or fresh frozen plasma. Fresh whole autologous blood transfusions had no significant hemostatic effect and failed to reduce the homologous blood requirement. Conversely, high-dose aprotinin reduced blood loss and transfusion requirements.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hôpital Cardiologique Louis Pradel, Lepine, France.
authors.forename: C
authors.initials: C
authors.lastname: Vedrinne
authors.forename: C
authors.initials: C
authors.lastname: Girard
authors.forename: O
authors.initials: O
authors.lastname: Jegaden
authors.forename: P
authors.initials: P
authors.lastname: Blanc
authors.forename: H
authors.initials: H
authors.lastname: Bouvier
authors.forename: P
authors.initials: P
authors.lastname: Ffrench
authors.forename: P
authors.initials: P
authors.lastname: Mikaeloff
authors.forename: S
authors.initials: S
authors.lastname: Estanove
mesh_terms: D000328:Adult; D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies
chemical_list: D006454:Hemoglobins; D005340:Fibrinogen; D007611:Aprotinin