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J Thorac Cardiovasc Surg 2008;135:495-502
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Bleeding in cardiac surgery: The use of aprotinin does not affect survival

^a Department of Cardiothoracic Surgery, University Hospital Birmingham, Birmingham, United Kingdom
^d Department of Clinical Biochemistry, University Hospital Birmingham, Birmingham, United Kingdom
^b Health Care Evaluation Group, University of Birmingham, Birmingham, United Kingdom
^c NHS Health and Social Services Information Centre, Leeds, United Kingdom
^e National Institute for Clinical Outcomes Research, University College London, London, United Kingdom

Received for publication July 20, 2007; revisions received October 16, 2007; accepted for publication November 8, 2007.

^_* Address for reprints: D. Pagano, MD, FRCS, Department Cardiothoracic Surgery, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, United Kingdom. (Email: domenico.pagano{at}uhb.nhs.uk).

Objective: The antifibrinolytic drug aprotinin has been the most widely used agent to reduce bleeding and its complications in cardiac surgery. Several randomized trials and meta-analyses have demonstrated it to be effective and safe. However, 2 recent reports from a single database have implicated the use of aprotinin as a risk for postoperative complications and reduced long-term survival.

Methods: In this single-institution observational study involving 7836 consecutive patients (1998–2006), we assessed the safety of using aprotinin in risk reduction strategy for postoperative bleeding.

Results: Aprotinin was used in 44% of patients. Multivariate analysis identified aprotinin use in risk reduction for reoperation for bleeding (odds ratio, 0.51; 95% confidence interval, 0.36–0.72; P = .001) and need for blood transfusion postoperatively (odds ratio, 0.67; 95% confidence interval, 0.57–0.79; P = .0002). The use of aprotinin did not affect in-hospital mortality (odds ratio, 1.03; 95% confidence interval, 0.71–1.49; P = 0.73), intermediate-term survival (median follow-up, 3.4 years; range, 0–8.9 years; hazard ratio, 1.09; 95% confidence interval, 0.93–1.28; P = .30), incidence of postoperative hemodialysis (odds ratio, 1.16; 95% confidence interval, 0.73–1.85; P = .49), and incidence of postoperative renal dysfunction (odds ratio, 0.78; 95% confidence interval, 0.59–1.03; P = .07).

Conclusion: This study demonstrates that aprotinin is effective in reducing bleeding after cardiac surgery, is safe, and does not affect short- or medium-term survival.

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