POSTOPERATIVE APROTININ - EFFECT ON BLOOD-LOSS AND TRANSFUSION REQUIREMENTS IN CARDIAC OPERATIONS

Background. Aprotinin has been used increasingly to reduce postoperati ve blood loss in open heart operations. Although it was reported as sa fe in earlier studies, the overall safety of prophylactic use has been questioned recently. Because of the potential for complications and t he high cost, it will be reasonable to use aprotinin more selectively in the postoperative period. Methods. We prospectively studied the eff ect of postoperative low-dose aprotinin (2 million kallikrein inactiva tor units [280 mg]) on blood loss and transfusion requirements in pati ents undergoing cardiopulmonary bypass. Seventy-five patients were ran domly assigned to three groups: prophylactic high-dose aprotinin (grou p 1), postoperative aprotinin (group 2), or a nonmedicated control gro up (group 3). Results. The three groups were comparable in all demogra phic and operative variables. Postoperative chest tube drainage was si gnificantly decreased in both aprotinin groups compared with that in t he control group (295 mL in group 1 and 325 mL in group 2 versus 411 m L in group 3; p < 0.05). No significant difference was seen between th e two aprotinin groups. The use of homologous blood products was signi ficantly less in group 1 and group 2 than in group 3 (1.15 +/- 1.13 U and 1.35 +/- 1.30 U versus 2.55 +/- 1.09 U; p < 0.05). Conclusions. Ou r results suggest that postoperative aprotinin reduces blood loss and transfusion requirements comparably with prophylactic high-dose aproti nin. Thus, one can restrict its use to patients with excessive postope rative bleeding.