title: Randomized, placebo-controlled, double-blind study of an ultra-low-dose aprotinin regimen in reoperative and/or complex cardiac operations.
abstract: OBJECTIVE
  High-dose aprotinin is an effective but costly method to reduce transfusions after cardiopulmonary bypass (CPB). Very low doses of aprotinin have been shown to be effective in primary cardiac surgery, but not in patients undergoing procedures associated with the greatest usage of allogeneic blood products after CPB. We evaluated the efficacy of ultra-low-dose aprotinin in this patient population.
  
  
  METHODS
  Aprotinin 1 million KIU or placebo was added to the priming solution of the CPB circuit of 52 patients undergoing a reoperation and/or a complex surgical procedure. Dryness of operative field, hemoglobin concentrations, coagulation parameters, chest drainage, and transfusion requirements were compared.
  
  
  RESULTS
  Total chest drainage was not different between groups, but fewer patients in the aprotinin group required additional protamine postoperatively (35% vs 69% for controls, p = 0.03) and fewer received fresh frozen plasma (FFP; 19% vs 46% for controls, p = 0.04). Red cell transfusion was smaller in the aprotinin group compared to placebo (median 4 and 2 units, respectively, p = 0.04). Transfusion of FFP, platelets, cryoprecipitates was not different between groups. Total number of units transfused tended to be reduced in the aprotinin group compared to control (median 2 and 7 units, respectively, p = 0.06).
  
  
  CONCLUSIONS
  Prophylactic administration of ultra-low-dose aprotinin reduced transfusions in patients undergoing repeat operations or complex procedures. Aprotinin could be used in a more economical manner, even in this patient population at high-risk of receiving allogeneic blood products.
authors.affiliation: Department of Anesthesia, Université de Montréal, Québec. hardy@icm.umontreal.ca
authors.forename: J F
authors.initials: JF
authors.lastname: Hardy
authors.forename: S
authors.initials: S
authors.lastname: Bélisle
authors.forename: A
authors.initials: A
authors.lastname: Couturier
authors.forename: D
authors.initials: D
authors.lastname: Robitaille
mesh_terms: D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage* / Q000627:therapeutic use; D001803:Blood Transfusion; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006490:Hemostatics / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011300:Preoperative Care; D011315:Preventive Medicine; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D010919:Placebos; D007611:Aprotinin