Aprotinin use during cardiac surgery: recent alterations and effects on blood product utilization.
OBJECTIVE
To investigate a single institution's changing use of aprotinin and subsequent effects on intraoperative blood product utilization (red blood cells/fresh frozen plasma) and postoperative clinical bleeding requiring reoperation.


METHODS
Retrospective study.


METHODS
Single university institution (University of Chicago).


METHODS
Data from 499 adult patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) over a two-year period (February 2005 - January 2007) were reviewed. The first 12 months (Feb 2005 - Jan 2006, Group 2005-2006) of data were compared with that from the second 12-month period (Feb 2006 - Jan 2007, Group 2006-2007). Information regarding patient demographics, surgical procedures, aprotinin use (none, half-dose, full-dose), and blood product use during CPB was retrospectively retrieved and analyzed.


RESULTS
When Group 2006-2007 data was compared with that from Group 2005-2006, full-dose aprotinin use had significantly decreased (58% to 17%, P < 0.001), non-use of aprotinin significantly increased (18% to 47%, P < 0.001), while fresh frozen plasma (FFP) utilization during CPB significantly increased (24% to 36%, P = 0.004). Red blood cell (RBC) transfusion rates remained stable (67% - 69%) yet rates of RBC and FFP transfusion during CPB significantly increased (23% to 34%, P = 0.003). There was also a trend toward increased unplanned reoperations for excessive clinical bleeding (0 pts in Group 2005-2006, three pts in Group 2006-2007).


CONCLUSIONS
As the institution's use of high-dose aprotinin has significantly decreased, the number of patients requiring FFP and FFP/RBC combinations during CPB has significantly increased. Furthermore, a trend toward increasing incidence of unplanned reoperations for excessive clinical bleeding was noted.
Strouch
Zaneta Y
ZY
Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL 60637, USA.
Drum
Melinda L
ML
Chaney
Mark A
MA
D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004363:Drug Utilization; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D010949:Plasma; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
D007611:Aprotinin