title: Removal of aprotinin from low-dose aprotinin/tranexamic acid antifibrinolytic therapy increases transfusion requirements in cardiothoracic surgery.
abstract: This retrospective study investigated whether withdrawal of aprotinin from combined low-dose aprotinin/tranexamic acid (TXA) antifibrinolytic therapy altered postoperative blood loss and transfusion requirements in patients undergoing cardiothoracic surgery employing cardiopulmonary bypass (CPB). The study included data from patients receiving a combination of low-dose aprotinin (2×10(6) KIU in CPB prime; n=615) and 2000 mg TXA or patients receiving TXA only (n=587). In both groups, TXA was given after protamine administration. Study endpoints were blood loss, transfusion requirements and reoperation. There were no differences in EuroSCORE, CPB time, antiangial medication and baseline coagulation parameters between groups. There were more males in the TXA group (85%) as compared to the TXA+aprotinin group (77%; P=0.02). Postoperative blood loss (0.80±0.69 vs. 0.66±0.52 l; P=0.001) and transfusion of fresh frozen plasma (0.6±0.7 vs. 0.4±0.6 U; P<0.001), packed cells (3.9±5.5 vs. 2.7±3.3 U; P<0.001) and platelets (0.7±0.6 vs. 0.5±0.6 U; P<0.001) was higher in the TXA group than in patients receiving combined therapy, respectively. There were more reoperations for bleeding in the TXA group (53 vs. 34, respectively; P=0.03) with similar mortality and deterioration in glomerular filtration rate. In conclusion, withdrawal of aprotinin from combined antifibrinolytic therapy is associated with increased blood loss, transfusion requirements and reoperations.
authors.affiliation: Department of Cardio-Thoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. aba.vonk@vumc.nl
authors.forename: Alexander B A
authors.initials: AB
authors.lastname: Vonk
authors.forename: Michael I
authors.initials: MI
authors.lastname: Meesters
authors.forename: Joep
authors.initials: J
authors.lastname: Schats
authors.forename: Johannes W A
authors.initials: JW
authors.lastname: Romijn
authors.forename: Evert K
authors.initials: EK
authors.lastname: Jansen
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D007611:Aprotinin / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D006490:Hemostatics; D014148:Tranexamic Acid; D007611:Aprotinin