title: Living without aprotinin: the results of a 5-year blood saving program in cardiac surgery.
abstract: BACKGROUND
  After 20 years of regular use in cardiac surgery patients, aprotinin has recently been withdrawn from the market due to many concerns about its safety. For a number of reasons aprotinin has not been available in Italy since 1998. The present study presents an aprotinin-free treatment protocol applied at our institution during the last 5 years, and aims to verify the results of this protocol in terms of allogeneic blood product transfusions, postoperative blood loss and surgical re-exploration rate.
  
  
  METHODS
  Retrospective study on 7988 consecutive patients who underwent cardiac surgery during the years 2003-2007. All the patients received specific hemostasis/coagulation management based on (a) routine use of tranexamic acid, (b) heparin dose-response monitoring, thromboelastography, platelet (PLT) function analysis in a select population of patients, and (c) use of fresh frozen plasma (FFP), PLTs, and desmopressin according to the hemostasis/coagulation profile. Data retrieved from the institutional database were quantity of packed red cells (PRCs), FFP, PLT transfusion rate, blood loss in the first 12 postoperative hours, and surgical re-exploration rate.
  
  
  RESULTS
  PRCs were transfused in 40.4% of patients (with higher rates for selected high-risk subpopulations), FFP in 12.9% and PLTs in 2.6%. Surgical re-exploration rate was 3.7%. With respect to historical controls, a significant reduction of PRCs and FFP transfusions was obtained using closed circuits, point of care coagulation tests, and combination of the two.
  
  
  CONCLUSIONS
  This aprotinin-free blood saving program is an effective strategy for allogeneic blood products transfusion containment.
authors.affiliation: Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico S. Donato, Milan, Italy. cardioanestesia@virgilio.it
authors.forename: M
authors.initials: M
authors.lastname: Ranucci
authors.forename: S
authors.initials: S
authors.lastname: Castelvecchio
authors.forename: F
authors.initials: F
authors.lastname: Romitti
authors.forename: G
authors.initials: G
authors.lastname: Isgrò
authors.forename: A
authors.initials: A
authors.lastname: Ballotta
authors.forename: D
authors.initials: D
authors.lastname: Conti
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D007611:Aprotinin / Q000009:adverse effects*; D001777:Blood Coagulation / Q000502:physiology; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D016208:Databases, Factual; D004363:Drug Utilization; D005260:Female; D006487:Hemostasis; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D006493:Heparin; D007611:Aprotinin