title: Postoperatively administered aprotinin or epsilon aminocaproic acid after cardiopulmonary bypass has limited benefit.
abstract: BACKGROUND
  Intraoperative antifibrinolytic treatment with aprotinin and epsilon aminocaproic acid (EACA) has been shown to be effective prophylaxis in the reduction of excessive bleeding after cardiopulmonary bypass operations. This study investigated the effectiveness of both drugs when used as a postoperative treatment of patients showing early signs of increased bleeding.
  
  
  METHODS
  In a double-blind, randomized study, 69 patients with chest drainage of 100 mL or more 1 hour after bypass were treated with aprotinin, EACA, or placebo.
  
  
  RESULTS
  In the first 24 hours postoperatively, neither drug significantly reduced chest drainage or blood transfusion requirements compared with placebo. Median (interquartile) cumulative chest drainage volumes for the first 24 hours postoperatively for the aprotinin, EACA, and placebo groups were 525 (340, 750), 575 (450, 762), and 650 (550, 800) mL, respectively. Among the study patients, 4 undergoing valve operation and treated with aprotinin showed a trend toward less bleeding during the first 12 hours postoperatively compared with 5 valve operation patients who received placebo (p = 0.06). Among all patients, the treatment with aprotinin or EACA failed to reduce levels of D-dimer compared with placebo after treatment, indicating that fibrinolysis was not significantly inhibited.
  
  
  CONCLUSIONS
  Aprotinin or EACA administered in the early postoperative period was ineffective in reducing postoperative bleeding with the exception of a small group of patients having valve operations in whom aprotinin treatment may have shown some benefit.
authors.affiliation: Department of Haematology, The Prince Charles Hospital, Brisbane, Australia. michael_ray@health.qld.gov.au
authors.forename: M J
authors.initials: MJ
authors.lastname: Ray
authors.forename: M M
authors.initials: MM
authors.lastname: Hales
authors.forename: L
authors.initials: L
authors.lastname: Brown
authors.forename: M F
authors.initials: MF
authors.lastname: O'Brien
authors.forename: E G
authors.initials: EG
authors.lastname: Stafford
mesh_terms: D000368:Aged; D015119:Aminocaproic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D007611:Aprotinin / Q000008:administration & dosage* / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000188:drug therapy*; D017211:Treatment Failure
chemical_list: D007611:Aprotinin; D015119:Aminocaproic Acid