Low-dose aprotinin in cardiac operations.
BACKGROUND
Patients with heart disease are frequently maintained on a regimen of aspirin. During cardiac surgery aspirin-induced platelet dysfunction increases the risk of bleeding.


METHODS
The files of 82 patients who had undergone open-heart surgery were selected to study the efficacy of the low-dose (2 million KIU) aprotinin regimen in decreasing blood loss and transfusion requirements for patients receiving aspirin. Patients were divided into three groups: Group 1, includes those who received neither aspirin nor aprotinin (n = 41), Group 2, received both aspirin and aprotinin (n = 27) and Group 3, did not receive aprotinin despite aspirin intake (n = 14). Primary outcome measures in this study were total volume of blood loss (postoperative chest tube drainage) and volume of transfusions during hospitalization.


RESULTS
Patients treated with aprotinin (Group 2) had significantly lower total blood loss (359 ml versus 527 ml and 628 ml in Group 1 and Group 3, p < 0.05), rates of bleeding (17.2 ml/hr versus 25.7 and 30.4 ml/hr in groups 1 and 3 respectively). A significant difference was also found when comparing the volume of blood transfusions (224.4 ml versus 262.4 and 537.5 ml) and prevalence of transfusion (33.3% versus 36.6% and 64.3%).


CONCLUSIONS
Low-dose aprotinin significantly reduces blood loss and blood transfusions in patients receiving aspirin who undergo cardiac operations.
Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon. mrsmith@dm.net.lb
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Haddad
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Kesrouani
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Nasr
D007611:Aprotinin / Q000008:administration & dosage*; D001241:Aspirin / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015505:Chest Tubes; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004322:Drainage / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D015842:Serine Proteinase Inhibitors; D007611:Aprotinin; D001241:Aspirin