title: Switch from aprotinin to ε-aminocaproic acid: impact on blood loss, transfusion, and clinical outcome in neonates undergoing cardiac surgery.
abstract: BACKGROUND
  With the withdrawal of aprotinin from worldwide marketing in November 2007, many institutions treating patients at high risk for hyperfibrinolysis had to update their therapeutic protocols. At our institution, the standard was switched from aprotinin to ε-aminocaproic acid (EACA) in all patients undergoing cardiac surgery with extracorporeal circulation including neonates. Although both antifibrinolytic medications have been used widely for many years, there are few data directly comparing their blood-sparing effect and their side-effects especially in neonates.
  
  
  METHODS
  Perioperative data from 235 neonates aged up to 30 days undergoing primary cardiac surgery were analysed. Between July 1, 2006 and November 5, 2007, all patients (n=95) received aprotinin. Starting November 6, 2007 until December 31, 2009, all patients (n=140) were treated with EACA. The primary outcome criterion was blood loss; secondary outcome criteria were transfusion requirements, renal, vascular, and neurological complications and also in-hospital mortality.
  
  
  RESULTS
  All descriptive and intraoperative data variable were similar. Blood loss was significantly higher in the EACA group (P=0.001), but there was no difference in the rate of re-operation for bleeding (P=0.218) nor the number of transfusions. There were no differences in the incidences of postoperative renal, neurological, and vascular events or in-hospital mortality.
  
  
  CONCLUSIONS
  In neonatal patients undergoing cardiac surgery, the switch to EACA treatment led to a higher postoperative blood loss. However, there were no differences in transfusion requirements or major clinical outcomes.
authors.affiliation: Department of Anaesthesiology, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636 Munich, Germany. martin@dhm.mhn.de
authors.forename: K
authors.initials: K
authors.lastname: Martin
authors.forename: R
authors.initials: R
authors.lastname: Gertler
authors.forename: H
authors.initials: H
authors.lastname: Liermann
authors.forename: N P
authors.initials: NP
authors.lastname: Mayr
authors.forename: M
authors.initials: M
authors.lastname: MacGuill
authors.forename: C
authors.initials: C
authors.lastname: Schreiber
authors.forename: M
authors.initials: M
authors.lastname: Vogt
authors.forename: P
authors.initials: P
authors.lastname: Tassani
authors.forename: G
authors.initials: G
authors.lastname: Wiesner
mesh_terms: D015119:Aminocaproic Acid / Q000627:therapeutic use*; D007611:Aprotinin / Q000627:therapeutic use*; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019106:Postoperative Hemorrhage / Q000188:drug therapy*
chemical_list: D006490:Hemostatics; D007611:Aprotinin; D015119:Aminocaproic Acid