Changing from aprotinin to tranexamic acid results in increased use of blood products and recombinant factor VIIa for aortic surgery requiring hypothermic arrest.
OBJECTIVE
Aprotinin, once used to reduce allogeneic blood product transfusion during cardiac surgery, was withdrawn from the market in late 2007 over concerns of causing increased mortality. This study was undertaken to determine what, if any, the impact of changing antifibrinolytic agents (from aprotinin to tranexamic acid) for deep hypothermic circulatory arrest cases would have on blood bank resource utilization.


METHODS
This a retrospective review.


METHODS
All cases were performed at a single university hospital.


METHODS
All patients underwent cardiac surgical procedures requiring deep hypothermic circulatory arrest performed by a single cardiac surgeon between January 2006 and November 2008.


METHODS
All patients prior to November 15, 2007 received aprotinin as antifibrinolytic therapy, while those after that date received tranexamic acid for antifibrinolytic therapy.


RESULTS
Blood transfusion data and recombinant factor VIIa use during the pre- and immediate postoperative period was collected for all patients during the study time period. There were no significant differences between the aprotinin (n = 82) and tranexamic acid (n = 78) groups with regard to baseline coagulation status or operative characteristics. Patients treated with tranexamic acid required more fresh frozen plasma (2.5 units, p < 0.001), platelets (0.5 units, p < 0.01), and cryoprecipitate (25 units, p < 0.001), and had a higher incidence of recombinant factor VIIa use (34.6% v 12.2%, p < 0.01) compared with patients in the aprotinin group.


CONCLUSIONS
Patients treated with tranexamic acid required more clotting factors than the control group receiving aprotinin.
Sniecinski
Roman M
RM
Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, USA. roman.sniecinski@emory.edu
Chen
Edward P
EP
Makadia
Sunal S
SS
Kikura
Mutsuhito
M
Bolliger
Daniel
D
Tanaka
Kenichi A
KA
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D007611:Aprotinin / Q000627:therapeutic use*; D015415:Biomarkers; D001772:Blood Cell Count; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000191:economics; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000191:economics; D015331:Cohort Studies; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use*
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D015415:Biomarkers; D011994:Recombinant Proteins; D014148:Tranexamic Acid; D007611:Aprotinin; C103587:recombinant FVIIa; D015942:Factor VIIa