Aprotinin and tranexamic acid for high transfusion risk cardiac surgery.
BACKGROUND
Studies have shown that aprotinin and tranexamic acid can reduce postoperative blood loss after cardiac operation. However, which drug is more efficacious in a higher risk surgical group of patients, has yet to be defined in a randomized study.


METHODS
With informed consent, 80 patients undergoing elective high transfusion risk cardiac procedures (repeat sternotomy, multiple valve, combined procedures, or aortic arch operation) were randomized in a double-blind fashion, to receive either high dose aprotinin or tranexamic acid. Patient and operative characteristics, chest tube drainage and transfusion requirements were recorded.


RESULTS
There was no significant difference between the 2 treatment groups with respect to age, cardiopulmonary bypass time, complications (myocardial infarction, stroke, death), chest tube drainage (6, 12, or 24 hours), blood transfusions up to 24 hours postoperatively, total allogeneic blood transfusions for entire hospital stay, or induction/postoperative hemoglobin levels. However, multiple regression analysis revealed a positive relationship between cardiopulmonary bypass time and 24 hour blood loss in the tranexamic acid group (p = 0.001), unlike the aprotinin group where 24 hour blood loss is independent of cardiopulmonary bypass time (p = 0.423).


CONCLUSIONS
Overall, there was no significant difference in blood loss, or transfusion requirements, when patients received either aprotinin or tranexamic acid for high transfusion risk cardiac operation. Aprotinin, when given as an infusion in a high-dose regimen, was able to negate the usual positive effect of cardiopulmonary bypass time on chest tube blood loss.
Wong
B I
BI
Department of Anesthesia, Sunnybrook and Women's College Health Science Center, University of Toronto, Ontario, Canada. bill.wong@utoronto.ca
McLean
R F
RF
Fremes
S E
SE
Deemar
K A
KA
Harrington
E M
EM
Christakis
G T
GT
Goldman
B S
BS
D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D007611:Aprotinin / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004311:Double-Blind Method; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012044:Regression Analysis; D012307:Risk Factors; D014148:Tranexamic Acid / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D006490:Hemostatics; D014148:Tranexamic Acid; D007611:Aprotinin