POSTOPERATIVE USE OF APROTININ IN CARDIAC OPERATIONS - AN ALTERNATIVETO ITS PROPHYLACTIC USE

Background: Aprotinin reduces blood loss after cardiopulmonary bypass, Although there can be little doubt about the efficacy of aprotinin, i ts safety has been questioned recently and is still under investigatio n. Because of the potential for complications and the high cost, a sel ective strategy limiting drug delivery to patients with established po stoperative bleeding will be more reasonable. Methods: In a prospectiv e, randomized, double-blind trial we studied the effect of postoperati ve low-dose (2 million kallikrein inactivator units) aprotinin on bloo d loss and transfusion requirements in patients undergoing cardiopulmo nary bypass, Fifty-seven patients were randomly assigned to two groups : aprotinin or placebo, Results: The two groups were comparable in all demographic and surgical variables. Postoperative chest tube drainage was significantly less in the aprotinin group than in the placebo gro up (410 ml vs 696 ml, p < 0.01), The use of homologous blood products was significantly less in the aprotinin group than in the placebo grou p (0.4 +/- 0.5 unit vs 1.7 +/- 0.9 unit for packed red blood cells and 0.8 +/- 1.3 unit vs 2.3 +/- 1.6 unit for fresh frozen plasma), Conclu sions: Our results suggest that postoperative aprotinin reduces blood loss and transfusion requirements and provides the opportunity to rest rict its use selectively to patients with excessive postoperative blee ding.