title: High-dose aprotinin, blood product transfusions, and short-term outcome in neonates and infants: a pediatric cardiac surgery center experience.
abstract: BACKGROUND
  The efficacy of aprotinin, the most popular antifibrinolytic agent in congenital cardiac surgery, was still uncertain in small infants when its prophylactic use was suspended for safety reasons. The aim of this study is to describe associations between the prophylactic use of high-dose aprotinin, the need for blood product transfusions, and short-term outcome in neonates and infants with cardiac surgery.
  
  
  METHODS
  This retrospective study included all patients younger than 1 year undergoing surgery with cardiopulmonary bypass through 42 months, before and after withdrawal of aprotinin. Each patient who received aprotinin was matched with a control with similar baseline and surgical characteristics, who have not received any antifibrinolytic agent. Associations between the use of aprotinin and the exposure to red blood cells, fresh frozen plasma, and platelet transfusions were estimated from a logistic regression model, and the exposure to additional transfusions from a polytomous regression model.
  
  
  RESULTS
  Matching resulted in two groups of 283 patients each, well balanced except for the priming volume and the ultrafiltration rate, larger in the aprotinin group. After adjustment for the priming volume and ultrafiltration rate, there was no significant association between the use of aprotinin, the exposure to any blood product transfusion, or the exposure to additional transfusions, the rate of re-exploration for bleeding, and short-term outcome. Two patients in the control group required re-exploration for bleeding.
  
  
  CONCLUSIONS
  No association was found between the prophylactic use of aprotinin, blood product transfusions, and short-term outcome in this population of neonates and infants.
authors.affiliation: Anesthesiolgy and Critical Care Department, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris, Paris, France. mirela.bojan@nck.aphp.fr
authors.forename: Mirela
authors.initials: M
authors.lastname: Bojan
authors.forename: Claire
authors.initials: C
authors.lastname: Boulat
authors.forename: Harlinde
authors.initials: H
authors.lastname: Peperstraete
authors.forename: Philippe
authors.initials: P
authors.lastname: Pouard
mesh_terms: D000768:Anesthesia, General; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016913:Blood Component Transfusion / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care; D010949:Plasma; D017713:Platelet Transfusion; D057766:Policy; D011182:Postoperative Care; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014462:Ultrafiltration
chemical_list: D000933:Antifibrinolytic Agents; D007611:Aprotinin