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J Thorac Cardiovasc Surg 1996;112:1462-1467
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

POSTOPERATIVE USE OF APROTININ IN CARDIAC OPERATIONS: AN ALTERNATIVE TO ITS PROPHYLACTIC USE

From Department of Cardiovascular Surgery, GATA Gülhane School of Medicine, Ankara, Turkey.

Received for publication March 19, 1996 Revisions requested April 22, 1996; revisions received May 7, 1996 Accepted for publication May 14, 1996. Address for reprints: Sertaç Çiçek, MD, Section of Cardiovascular Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.

Abstract

Background: Aprotinin reduces blood loss after cardiopulmonary bypass. Although there can be little doubt about the efficacy of aprotinin, its safety has been questioned recently and is still under investigation. Because of the potential for complications and the high cost, a selective strategy limiting drug delivery to patients with established postoperative bleeding will be more reasonable.
Methods: In a prospective, randomized, double-blind trial we studied the effect of postoperative low-dose (2 million kallikrein inactivator units) aprotinin on blood loss and transfusion requirements in patients undergoing cardiopulmonary bypass. Fifty-seven patients were randomly assigned to two groups: aprotinin or placebo.
Results: The two groups were comparable in all demographic and surgical variables. Postoperative chest tube drainage was significantly less in the aprotinin group than in the placebo group (410 ml vs 696 ml, p < 0.01). The use of homologous blood products was significantly less in the aprotinin group than in the placebo group (0.4 ± 0.5 unit vs 1.7 ± 0.9 unit for packed red blood cells and 0.8 ± 1.3 unit vs 2.3 ± 1.6 unit for fresh frozen plasma).
Conclusions: Our results suggest that postoperative aprotinin reduces blood loss and transfusion requirements and provides the opportunity to restrict its use selectively to patients with excessive postoperative bleeding. (J THORACCARDIOVASCSURG1996;112:1462-7)

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