The impact of aprotinin on blood loss and blood transfusion in off-pump coronary artery bypass grafting.
BACKGROUND
Administration of the serine protease inhibitor aprotinin has been proven efficacious in cardiopulmonary bypass-supported cardiac surgery to reduce bleeding and transfusion requirements. Its role in off-pump surgery is not so well defined. The present study assessed the effect of aprotinin in off-pump coronary artery bypass grafting on perioperative blood loss and transfusion rates.


METHODS
A total of 761 consecutive adult patients who underwent off-pump coronary artery bypass grafting were retrospectively reviewed. The majority (87%) received aspirin preoperatively. Heparin was intravenously administered for a kaolin-based activated clotting time of greater than 300 seconds. Aprotinin was administered as a 1 million or 2 million kallikrein inhibiting unit bolus to 391 patients after median sternotomy. The control group (n = 370) underwent surgery during the same period without receiving aprotinin. Blood loss was measured intraoperatively (cell-saving device) and postoperatively by quantifying mediastinal chest tube drainage.


RESULTS
Aprotinin was associated with a significant reduction in postoperative blood loss (p < 0.001) and less excessive postoperative hemorrhage (p < 0.001) compared with the control group. Transfusion rates and amount of blood products administered were also reduced by aprotinin (p < 0.01 for both). Significantly more patients in the aprotinin group were free of any blood product transfusion (54.7%) compared with the control group (41.4%; p < 0.01). The safety profile was comparable between aprotinin and control patients.


CONCLUSIONS
Aprotinin proved efficacious and safe in the reduction of postoperative bleeding and transfusion requirements in patients undergoing off-pump coronary artery bypass grafting.
Bittner
Hartmuth B
HB
Heart Center of the University of Leipzig, Cardiovascular and Thoracic Surgery, Leipzig, Germany. heartbeatgermany@aol.com
Lemke
Janine
J
Lange
Michelle
M
Rastan
Ardawan
A
Mohr
Friedrich W
FW
D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control*; D001803:Blood Transfusion; D047549:Coronary Artery Bypass, Off-Pump; D004906:Erythrocyte Count; D005260:Female; D006400:Hematocrit; D006452:Hemoglobinometry; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage*; D016896:Treatment Outcome
D006490:Hemostatics; D015842:Serine Proteinase Inhibitors; D007611:Aprotinin