[The use of antifibrinolytics in heart surgery. 3 prospective studies].
In order to assess the validity of antifibrinolytic treatments in cardiac surgery, three successive controlled randomized double-blind studies were carried out in patients undergoing a first (n = 60) or repeat surgical procedure because of a valvular or coronary disease. The first study aimed at stating the value of low doses of aprotinin compared with "classical" ones and a placebo. The second study was planned to compare tranexamic acid with low-dosed aprotinin and a placebo. The last study applied to reiterated procedures and compared tranexamic acid with classical and reduced aprotinin dosages, without a placebo group. Effects were estimated on postoperative bleeding, blood transfusions, platelets function and possible complications such as thrombosis or seric creatinine elevation. A reduced bleeding was observed in the non-placebo groups of studies I and II. The 3d study did not show any significant differences in this respect between the three methods. Tranexamic acid was found as effective as aprotinin on platelets function. No significant changes of seric creatinine was observed from preoperative to 4th postoperative day. A valvular non-obstructive thrombosis occurred on the second postoperative week in the tranexamic acid group.
Cousin
M T
MT
Service d'Anesthésie-Réanimation chirurgicale, Hôpital Broussais, Paris.
Boughenou
F
F
Madi-Jebara
S
S
Massonnet-Vastel
S
S
Benmosbah
L
L
D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007611:Aprotinin / Q000008:administration & dosage / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects / Q000502:physiology; D006348:Cardiac Surgical Procedures; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D010297:Paris / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013927:Thrombosis / Q000453:epidemiology; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D007611:Aprotinin; D003404:Creatinine