Low-dose postoperative aprotinin reduces mediastinal drainage and blood product use in patients undergoing primary coronary artery bypass grafting who are taking aspirin: A prospective, randomized, double-blind, placebo-controlled trial
Jm. Alvarez et al., Low-dose postoperative aprotinin reduces mediastinal drainage and blood product use in patients undergoing primary coronary artery bypass grafting who are taking aspirin: A prospective, randomized, double-blind, placebo-controlled trial, J THOR SURG, 122(3), 2001, pp. 457-463
Citations number
25
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background: Although low-dose aprotinin administered after cardiopulmonary
bypass has been reported to reduce mediastinal blood loss and blood product
requirements in patients not taking aspirin, it is unknown whether low-dos
e postoperative aprotinin has any beneficial effects in patients undergoing
coronary artery bypass operations who are at high risk of excessive postop
erative bleeding and increased transfusion requirements because of aspirin
use until just before the operation.
Methods: Fifty-five patients undergoing primary coronary artery operations
with cardiopulmonary bypass who continued taking aspirin (150 mg/d) until t
he day before the operation were enrolled in a prospective, randomized, dou
ble-blind trial to receive a single dose of either placebo (n = 29) or 2 x
10(6) kallikrein inhibiting units of aprotinin (n = 26) at the time of ster
nal skin closure.
Results: Patients in the aprotinin group had a lower rate (28 +/- 18 vs 43
+/- 21 mL/h [mean standard deviation], P <.005) and total volume of mediast
inal drainage (955 +/- 615 vs 1570 +/- 955 mL, P <.007), as well as a short
er duration of mediastinal drain tube insertion (24.4 +/- 13.8 vs 31.3 +/-
16.5 hours, P <.05). In addition, a smaller proportion of patients receivin
g aprotinin required a blood product (31% vs 62%, P =.03), resulting in a r
eduction in the use of packed cells by 47% (P =.05), platelets by 77% (P =.
01), fresh frozen plasma by 88% (P =.03), and total blood products by 68% (
P =.01) in this group.
Conclusions: These results suggest that postoperative administration of low
-dose aprotinin in patients taking aspirin until just before primary corona
ry artery operations with cardiopulmonary bypass not only reduces the rate
and total amount of postoperative mediastinal blood loss but also lowers po
stoperative blood product use.