Comparison of blood-conservation strategies in cardiac surgery patients athigh risk for bleeding

Background: Aprotinin and tranexamic acid are routinely used to reduce blee ding in cardiac surgery. There is a large difference in agent price and per haps in efficacy. Methods: in a prospective, randomized, partially blinded study, 168 cardiac surgery patients at high risk for bleeding received either a full-dose apr otinin infusion, tranexamic acid (10-mg/kg load, 1.mg.kg(-1).h(-1) infusion ), tranexamic acid with pre-cardiopulmonary bypass autologous whole-blood c ollection (12.5% blood volume) and reinfusion after cardiopulmonary bypass (combined therapy), or saline infusion (placebo group). Results: There were complete data in 160 patients. The aprotinin (n = 40) a nd combined therapy (n = 32) groups (data are median [range]) had similar r eductions in blood loss in the first 4 h in the intensive care unit (225 [4 0-761] and 163[25-760] mi, respectively; P = 0.014), erythrocyte transfusio n requirements in the first 24 h in the intensive care unit (0 [0-3] and 0 [0-3] U, respectively; P = 0.004), and durations of time from end of cardio pulmonary bypass to discharge from the operating room (92[57-215] and 94 [3 7, 186] min, respectively; P = 0.01) compared with the placebo group (n = 4 3). Ten patients in the combined therapy group (30.3%) required transfusion of the autologous blood during cardiopulmonary bypass for anemia. Conclusions: The combination therapy of tranexamic acid and intraoperative autologous blood collection provided similar reduction in blood loss and tr ansfusion requirements as aprotinin. Cost analyses revealed that combined t herapy and tranexamic acid therapy were the least costly therapies.