Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding.
BACKGROUND
Aprotinin and tranexamic acid are routinely used to reduce bleeding in cardiac surgery. There is a large difference in agent price and perhaps in efficacy.


METHODS
In a prospective, randomized, partially blinded study, 168 cardiac surgery patients at high risk for bleeding received either a full-dose aprotinin infusion, tranexamic acid (10-mg/kg load, 1-mg x kg(-1) x h(-1) infusion), tranexamic acid with pre-cardiopulmonary bypass autologous whole-blood collection (12.5% blood volume) and reinfusion after cardiopulmonary bypass (combined therapy), or saline infusion (placebo group).


RESULTS
There were complete data in 160 patients. The aprotinin (n = 40) and combined therapy (n = 32) groups (data are median [range]) had similar reductions in blood loss in the first 4 h in the intensive care unit (225 [40-761] and 163 [25-760] ml, respectively; P = 0.014), erythrocyte transfusion requirements in the first 24 h in the intensive care unit (0 [0-3] and 0 [0-3] U, respectively; P = 0.004), and durations of time from end of cardiopulmonary bypass to discharge from the operating room (92 [57-215] and 94 [37, 186] min, respectively; P = 0.01) compared with the placebo group (n = 43). Ten patients in the combined therapy group (30.3%) required transfusion of the autologous blood during cardiopulmonary bypass for anemia.


CONCLUSIONS
The combination therapy of tranexamic acid and intraoperative autologous blood collection provided similar reduction in blood loss and transfusion requirements as aprotinin. Cost analyses revealed that combined therapy and tranexamic acid therapy were the least costly therapies.
Nuttall
G A
GA
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA. nuttall.gregory@mayo.edu
Oliver
W C
WC
Ereth
M H
MH
Santrach
P J
PJ
Bryant
S C
SC
Orszulak
T A
TA
Schaff
H V
HV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000191:economics / Q000627:therapeutic use*; D007611:Aprotinin / Q000191:economics / Q000627:therapeutic use*; D001772:Blood Cell Count; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001793:Blood Preservation; D006348:Cardiac Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D006490:Hemostatics / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014148:Tranexamic Acid / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D006490:Hemostatics; D014148:Tranexamic Acid; D007611:Aprotinin