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J Thorac Cardiovasc Surg 2001;122:457-463
© 2001 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CPS)

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

From the Cardiothoracic Surgery Unit, Monash Medical Centre, and the Centre for Heart and Chest Research, Departments of Medicine and Surgery, Monash University, Clayton, Victoria, Australia.

Presented at the Forty-seventh Annual Scientific Meeting, Cardiac Society of Australia and New Zealand, Wellington, New Zealand, August 1999.

Received for publication Nov 6, 2000. Revisions requested Jan 8, 2001; revisions received Feb 28, 2001. Accepted for publication March 5, 2001. Address for reprints: J. M. Alvarez, MBBS, FRACS, Cardiothoracic Surgery Unit, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia (Email: john.alvarez{at}health.wa.gov.au).

Abstract

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-dose postoperative aprotinin has any beneficial effects in patients undergoing coronary artery bypass operations who are at high risk of excessive postoperative 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 the day before the operation were enrolled in a prospective, randomized, double-blind trial to receive a single dose of either placebo (n = 29) or 2 x 10⁶ kallikrein inhibiting units of aprotinin (n = 26) at the time of sternal 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 mediastinal drainage (955 ± 615 vs 1570 ± 955 mL, P < .007), as well as a shorter 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 receiving aprotinin required a blood product (31% vs 62%, P = .03), resulting in a reduction 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 coronary artery operations with cardiopulmonary bypass not only reduces the rate and total amount of postoperative mediastinal blood loss but also lowers postoperative blood product use.

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