EFFICACY AND SAFETY OF A BLOOD CONSERVATION PROGRAM INCLUDING LOW-DOSE APROTININ IN ROUTINE MYOCARDIAL REVASCULARIZATION

Objectives. We attempted to analyze the efficacy and safety of an exte nsive blood saving program applied in a large cohort of patients. Meas ures. flood saving included reinfusion of intraoperative predonated bl ood, aprotinin (2 million KIU) in the prime solution, reinfusion of an y residual volume, postoperative acceptance of normovolemic anemia (he matocrit greater than or equal to 25%) and autotransfusion of shed blo od. Setting, experimental design and patients. In our general hospital with a heart surgery service (1150 cases/year), we studied the record s of 527 non-selected consecutive patients, who were prospectively tre ated with this program being applied in primary myocardial revasculari zation between. Results. We avoided the use of donor blood in 86.9% of the patients requiring a mean of 0.2 +/- 0.01 unit of donor blood per patient. No repeat thoracotomy for bleeding was needed in any patient , Univariate analysis revealed that female gender; a low,level of hema tocrit, high age, a small stature, weight, body surface area, and red cell volume prebypass significantly (p < 0.001) were correlated to tre atment with donor blood. Multiple regression showed that a small red c ell volume and a low prebypass hematocrit were the most (p < 0.0001) s ignificant predictors for the use of donor blood. Observing a low inci dence of morbidity (myocardial infarction, gastrointestinal, neurologi cal thromboembolic, renal and wound complications), the safety of this program seems to be emphasized. Conclusions. Extensive blood saving i ncluding low-dose aprotinin reduced effectively and safely the need fo r donor blood in a large cohort of patients, but not in those patients with a small red cell volume and low hematocrit preoperatively.