HEMATOLOGIC AND ECONOMIC-IMPACT OF APROTININ IN REOPERATIVE PEDIATRICCARDIAC OPERATIONS

Background. Aprotinin consistently reduces blood loss and transfusion requirements in adults during and after cardiac surgical procedures, b ut its effectiveness in children is debated. We evaluated the hemostat ic and economic effects of aprotinin in children undergoing reoperativ e cardiac procedures with cardiopulmonary bypass. Methods. Control, lo w-dose aprotinin, and high-dose aprotinin groups were established with 15 children per group. Platelet counts, fibrinogen levels, and thromb oelastographic values at baseline and after protamine sulfate administ ration, number of blood product transfusions, and 6-hour and 24-hour c hest tube drainage were used to evaluate the effects of aprotinin on p ostbypass coagulopathies. Time needed for skin closure after protamine administration and lengths of stay in the intensive care unit and the hospital were recorded prospectively to determine the economic impact of aprotinin. Results. Coagulation tests performed after protamine ad ministration rarely demonstrated fibrinolysis but did show significant decreases in platelet and fibrinogen levels and function. The thrombo elastographic variables indicated a preservation of platelet function by aprotinin. Decreased blood product transfusions, shortened skin clo sure times, and shortened durations of intensive care unit and hospita l stays were found in the aprotinin groups, most significantly in the high-dose group with a subsequent average reduction of nearly $3,000 i n patient charges. Conclusions. In children undergoing reoperative car diac surgical procedures, aprotinin is effective in attenuating postby pass coagulopathies, decreasing blood product exposure, improving clin ical outcome, and reducing patient charges. (C) 1998 by The Society of Thoracic Surgeons.