title: Ultra-low dose aprotinin decreases transfusion requirements and is cost effective in coronary operations.
abstract: BACKGROUND
  The recommended dose of aprotinin has been shown to reduce blood loss and need for blood transfusions, but the cost precludes its routine use. This study was designed to determine whether a less expensive, ultra-low dose of aprotinin is effective when used in coronary artery bypass grafting with left internal mammary artery.
  
  
  METHODS
  Patients (n = 202) were randomized to receive either placebo or aprotinin, 0.5 million KIU before incision and 0.5 million KIU during initiation of cardiopulmonary bypass. Differences in quantity of blood transfused were analyzed. Further groups were analyzed to account for the effect of aspirin. Multivariable analysis was performed to determine risk factors for transfusion. Direct costs of blood products and aprotinin were tabulated for each group.
  
  
  RESULTS
  There was an important reduction in the proportion of patients transfused, and number of blood units transfused when aprotinin was given before coronary artery bypass grafting. These differences were even more important in patients on aspirin preoperatively. Independent predictors for increased number of transfusions were aspirin continued before operation, smaller body surface area, and the use of placebo instead of ultra-low dose aprotinin. There was no difference in morbidity between treatment groups. There was a reduction in direct costs associated with the use of aprotinin.
  
  
  CONCLUSIONS
  These data support the routine use of aprotinin 1 million KIU in coronary artery bypass grafting with left internal mammary artery to reduce cost and transfusion requirements.
authors.affiliation: Prince of Wales Hospital, Sydney, Australia. rebecca.dignan@surgery.mc.vanderbilt.edu
authors.forename: R J
authors.initials: RJ
authors.lastname: Dignan
authors.forename: D W
authors.initials: DW
authors.lastname: Law
authors.forename: P W
authors.initials: PW
authors.lastname: Seah
authors.forename: C W
authors.initials: CW
authors.lastname: Manganas
authors.forename: D C
authors.initials: DC
authors.lastname: Newman
authors.forename: P W
authors.initials: PW
authors.lastname: Grant
authors.forename: H D
authors.initials: HD
authors.lastname: Wolfenden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D007611:Aprotinin / Q000008:administration & dosage* / Q000191:economics; D001315:Australia; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000191:economics*; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D006490:Hemostatics / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged
chemical_list: D006490:Hemostatics; D007611:Aprotinin