Aprotinin and tranexamic acid for high transfusion risk cardiac surgery

Background. Studies have shown that aprotinin and tranexamic acid can reduc e postoperative blood loss after cardiac operation. However, which drug is more efficacious in a higher risk surgical group of patients, has yet: to b e defined in a randomized study. Methods. With informed consent, 80 patients undergoing elective high transf usion risk cardiac procedures (repeat sternotomy, multiple valve, combined procedures, or aortic arch operation) were randomized in a double-blind fas hion, to receive either high dose aprotinin or tranexamic acid. Patient and operative characteristics, chest tube drainage and transfusion requirement s were recorded. Results. There was no significant difference between We 2 treatment groups with respect to age, cardiopulmonary bypass time, complications (myocardial infarction, stroke, death), chest tube drainage (6, 12, or 24 hours), bloo d transfusions up to 24 hours postoperatively, total allogeneic blood trans fusions for entire hospital stay, or induction/postoperative hemoglobin lev els. However, multiple regression analysis revealed a positive relationship between cardiopulmonary bypass time and 24 hour blood loss in We tranexami c acid group (p = 0.001) unlike the aprotinin group where 24 hour blood los s is independent of cardiopulmonary bypass time (p = 0.423). Conclusions. Overall, there was no significant difference in blood loss, or transfusion requirements, when patients received either aprotinin or trane xamic acid for high transfusion risk cardiac operation, Aprotinin when give n as an infusion in a high-dose regimen, was able to negate We usual positi ve effect of cardiopulmonary bypass time on chest tube blood loss. (C) 2000 by The Society of Thoracic Surgeons.