RANDOMIZED STUDY OF APROTININ AND DDAVP TO REDUCE POSTOPERATIVE BLEEDING AFTER CARDIOPULMONARY BYPASS-SURGERY

Background Patients on cardiopulmonary bypass (CPB) have an increased susceptibility to postoperative bleeding. Previous reports using desmo pressin acetate (DDAVP) for the prevention of postoperative bleeding h ave given contradictory results, whereas the protease inhibitor aproti nin has been shown to reduce blood loss after this type of surgery. Th is randomized study was performed to assess the efficacy of DDAVP vers us aprotinin in the prevention of bleeding after CPB. Methods and Resu lts One hundred nine of 122 eligible patients were randomized to four different groups: Group A (n=28) received aprotinin starting with a bo lus of 2x10(6) KIU followed by a continuous infusion of 0.5x10(6) KIU/ h until the end of surgery; group B (n=25) received of DDAVP 0.3 mu g/ kg IV on completion of CPB; group C (n=28) received two doses of DDAVP , the first as in group B and an additional dose 6 hours after surgery ; group D (n=28) received no treatment. There was a marked reduction o f postoperative blood loss either at 12 hours (P<.01) or 72 hours (P<. 02) in the aprotinin group compared with all other groups, whereas no significant effect was observed in either of the two DDAVP regimens. A significant reduction in the amount of blood used was observed only i n the aprotinin group (P<.01). Of the plasma fibrinolytic components a ssayed, there was a significant reduction of the fibrin degradation pr oduct generation in the aprotinin group (P<.001), whereas a significan t systemic hyperfibrinolysis was observed in both DDAVP-treated groups and the control group. No side effects related to the study drugs wer e observed in any patient. Conclusions Aprotinin inhibited fibrinolysi s; this correlated with a significant reduction of postoperative blood loss and need for blood replacement after CPB. Neither one nor two do ses of DDAVP had a beneficial effect. Aprotinin offers a better altern ative than DDAVP in the prevention of bleeding after CPB.