FIBRINOLYTIC INHIBITORS AND THE PREVENTIO N OF BLEEDING IN CARDIAC VALVULAR SURGERY - COMPARISON OF TRANEXAMIC ACID AND HIGH-DOSE APROTININ

In order to assess the effects of tranexamic acid in comparison to the high dose regimen of aprotinin recommended by Royston and considered to be the reference in postoperative bleeding in cardiac surgery, 35 c onsecutive patients were randomised to two groups according to the pro duct prescribed. The global postoperative bleeding was comparable in t he two groups (p = 0.49). One surgical reoperation for haemostasis was required in the reference group. There was one case of renal failure in the same group due to cardiac failure. No thrombotic complications were observed. Platelet function, as judged by the bleeding time and p latelet aggregation to ristocetin, was the same in the two groups. The D-dimeres remained low in both groups, reflecting the absence of intr avascular coagulation and fibrinolysis. Tranexamic acid was as effecti ve and as safe as high dose aprotinin. These two substances, in additi on to their fibrinolytic inhibitory activity, conserved platelet prote ction by blocking the action of plasmin. These results seem to justify the preventive use of tranexamic acid from the moment of skin incisio n, especially in reoperation.