title: Bleeding in cardiac surgery: the use of aprotinin does not affect survival.
abstract: OBJECTIVE
  The antifibrinolytic drug aprotinin has been the most widely used agent to reduce bleeding and its complications in cardiac surgery. Several randomized trials and meta-analyses have demonstrated it to be effective and safe. However, 2 recent reports from a single database have implicated the use of aprotinin as a risk for postoperative complications and reduced long-term survival.
  
  
  METHODS
  In this single-institution observational study involving 7836 consecutive patients (1998-2006), we assessed the safety of using aprotinin in risk reduction strategy for postoperative bleeding.
  
  
  RESULTS
  Aprotinin was used in 44% of patients. Multivariate analysis identified aprotinin use in risk reduction for reoperation for bleeding (odds ratio, 0.51; 95% confidence interval, 0.36-0.72; P = .001) and need for blood transfusion postoperatively (odds ratio, 0.67; 95% confidence interval, 0.57-0.79; P = .0002). The use of aprotinin did not affect in-hospital mortality (odds ratio, 1.03; 95% confidence interval, 0.71-1.49; P = 0.73), intermediate-term survival (median follow-up, 3.4 years; range, 0-8.9 years; hazard ratio, 1.09; 95% confidence interval, 0.93-1.28; P = .30), incidence of postoperative hemodialysis (odds ratio, 1.16; 95% confidence interval, 0.73-1.85; P = .49), and incidence of postoperative renal dysfunction (odds ratio, 0.78; 95% confidence interval, 0.59-1.03; P = .07).
  
  
  CONCLUSIONS
  This study demonstrates that aprotinin is effective in reducing bleeding after cardiac surgery, is safe, and does not affect short- or medium-term survival.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Birmingham, Birmingham, United Kingdom. domenico.pagano@uhb.nhs.uk
authors.forename: Domenico
authors.initials: D
authors.lastname: Pagano
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Howell
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bonser
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Graham
authors.forename: Jorge
authors.initials: J
authors.lastname: Mascaro
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rooney
authors.forename: Ian C
authors.initials: IC
authors.lastname: Wilson
authors.forename: Rob
authors.initials: R
authors.lastname: Cramb
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Keogh
mesh_terms: D000368:Aged; D007611:Aprotinin / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016022:Case-Control Studies; D002423:Cause of Death; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D011336:Probability; D012016:Reference Values; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D007611:Aprotinin