The impact of aprotinin on blood loss and blood transfusion in off-pump coronary artery bypass grafting.

Abstract

BACKGROUND:

Administration of the serine protease inhibitor aprotinin has been proven efficacious in cardiopulmonary bypass-supported cardiac surgery to reduce bleeding and transfusion requirements. Its role in off-pump surgery is not so well defined. The present study assessed the effect of aprotinin in off-pump coronary artery bypass grafting on perioperative blood loss and transfusion rates.

METHODS:

A total of 761 consecutive adult patients who underwent off-pump coronary artery bypass grafting were retrospectively reviewed. The majority (87%) received aspirin preoperatively. Heparin was intravenously administered for a kaolin-based activated clotting time of greater than 300 seconds. Aprotinin was administered as a 1 million or 2 million kallikrein inhibiting unit bolus to 391 patients after median sternotomy. The control group (n = 370) underwent surgery during the same period without receiving aprotinin. Blood loss was measured intraoperatively (cell-saving device) and postoperatively by quantifying mediastinal chest tube drainage.

RESULTS:

Aprotinin was associated with a significant reduction in postoperative blood loss (p < 0.001) and less excessive postoperative hemorrhage (p < 0.001) compared with the control group. Transfusion rates and amount of blood products administered were also reduced by aprotinin (p < 0.01 for both). Significantly more patients in the aprotinin group were free of any blood product transfusion (54.7%) compared with the control group (41.4%; p < 0.01). The safety profile was comparable between aprotinin and control patients.

CONCLUSIONS:

Aprotinin proved efficacious and safe in the reduction of postoperative bleeding and transfusion requirements in patients undergoing off-pump coronary artery bypass grafting.

• Authors: Hartmuth B Bittner, Janine Lemke, Michelle Lange, Ardawan Rastan, Friedrich W Mohr
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 85 Issue 5 Pg. 1662-8 (May 2008) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 18442562 (Publication Type: Journal Article)

Chemical References

• Hemostatics
• Serine Proteinase Inhibitors
• Aprotinin

Topics

• Aged
• Aprotinin (administration & dosage)
• Blood Loss, Surgical (physiopathology, prevention & control)
• Blood Transfusion
• Coronary Artery Bypass, Off-Pump
• Erythrocyte Count
• Female
• Hematocrit
• Hemoglobinometry
• Hemostatics (administration & dosage)
• Humans
• Male
• Middle Aged
• Postoperative Hemorrhage (blood, prevention & control)
• Serine Proteinase Inhibitors (administration & dosage)
• Treatment Outcome