Efficacy and safety of a blood conservation program including low-dose aprotinin in routine myocardial revascularization.
OBJECTIVE
We attempted to analyze the efficacy and safety of an extensive blood saving program applied in a large cohort of patients.


METHODS
Blood saving included reinfusion of intraoperative predonated blood, aprotinin (2 million KIU) in the prime solution, reinfusion of any residual volume, postoperative acceptance of normovolemic anemia (hematocrit > or = 25%) and autotransfusion of shed blood. SETTING, EXPERIMENTAL DESIGN AND PATIENTS: In our general hospital with a heart surgery service (1150 cases/year), we studied the records of 527 non-selected consecutive patients, who were prospectively treated with this program being applied in primary myocardial revascularization between.


RESULTS
We avoided the use of donor blood in 86.9% of the patients requiring a mean of 0.2+/-0.01 unit of donor blood per patient. No repeat thoracotomy for bleeding was needed in any patient. Univariate analysis revealed that female gender, a low level of hematocrit, high age, a small stature, weight, body surface area, and red cell volume prebypass significantly (p<0.001) were correlated to treatment with donor blood. Multiple regression showed that a small red cell volume and a low prebypass hematocrit were the most (p<0.0001) significant predictors for the use of donor blood. Observing a low incidence of morbidity (myocardial infarction, gastrointestinal, neurological thromboembolic, renal and wound complications), the safety of this program seems to be emphasized.


CONCLUSIONS
Extensive blood saving including low-dose aprotinin reduced effectively and safely the need for donor blood in a large cohort of patients.
Schönberger
J P
JP
Department of Cardiopulmonary Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Woolley
S
S
Tavilla
G
G
Berreklouw
E
E
Bredée
J J
JJ
Mashhour
Y A
YA
Van Straten
B H
BH
Bavinck
J H
JH
Frietman
P A
PA
Everts
P A
PA
Wildevuur
Ch R
ChR
D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage*; D001782:Blood Donors; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous; D004911:Erythrocyte Volume; D005260:Female; D006400:Hematocrit; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012449:Safety
D006490:Hemostatics; D007611:Aprotinin