title: Comparative evaluation of the effects of tranexamic acid and low-dose aprotinin on post-valvular heart surgery bleeding and allogenic transfusion.
abstract: Bleeding diathesis and allogenic transfusion after complex heart surgery, such as heart valve surgery, may result in complications such as transfusion reaction, viral infection, postoperative infection, haemodynamic disturbance, prolonged stay in the intensive care unit and hospital, renal and respiratory failure and mortality. In this prospective, double-blind, randomized, placebo-controlled clinical trial, 90 patients were randomly divided into three groups: aprotinin, tranexamic acid and control. Chest-tube drainage, transfusion requirements and renal and neurological complications were evaluated. We found that chest-tube drainage during the first (P < 0.0001) and second 24 h (P = 0.001) after admission to the intensive care unit were significantly lower in the aprotinin group. The amounts of transfused packed red blood cells (P < 0.0001) and platelets (P = 0.02) were significantly lower in the aprotinin and tranexamic acid groups. The quantity of transfused fresh frozen plasma (P = 0.034) was significantly lower in the aprotinin group only. We did not find any neurological complications or renal failure in the three groups. Our data suggest that in valvular heart surgery, low-dose aprotinin is significantly better than tranexamic acid or a placebo for reduction of postoperative bleeding and allogenic transfusion, without increasing adverse outcomes.
authors.affiliation: Anaesthesiology and Critical Care Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran. mansouri@med.mui.ac.ir
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mansouri
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Attary
authors.forename: Keivan
authors.initials: K
authors.lastname: Bagheri
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Massoumi
authors.forename: Babak
authors.initials: B
authors.lastname: Ghavami
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D007611:Aprotinin / Q000008:administration & dosage* / Q000009:adverse effects; D001803:Blood Transfusion; D015505:Chest Tubes; D004311:Double-Blind Method; D004322:Drainage / Q000295:instrumentation; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006351:Heart Valves / Q000601:surgery*; D006490:Hemostatics / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007492:Iran; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011517:Prothrombin Time; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D014148:Tranexamic Acid; D007611:Aprotinin