Abstract

Background: Cardiac surgery is associated with perioperative bleeding and a significant consumption of allogenic blood products. Minimizing blood loss and transfusion requirements is of vital importance to avoid complication related to blood products transfusion. This study was done to compare the hemostatic effects of aprotinin and tranexamic acid (TA) on reducing bleeding and blood products transfusion in adult cardiac surgery.

Methods: A prospective study involved 100 patients, classified randomly into two groups (N=50 each). Group A patients received intravenous infusion of 2 000 000 kallikrein inhibitory units (KIU) of aprotinin over 30 minutes, then infusion of 500 000 KIU/hr throughout the operation and 2 000 000 aprotinin KIU) were added to the CPB circuit. Group B patients received TA as 20 mg/kg over 10 minutes, then infusion 5 mg/kg/hr throughout the operation. The effects of aprotinin and TA were monitored by ACT, PT, INR, aPTT, platelets, fibrinogen, D-dimer, troponin I, blood losses, blood products transfusion, duration of thorax closure and serum creatinine level.

Results: Both groups were comparable in their baseline demographic and surgical characteristics. The differences of ACT, PT, INR, aPTT, platelets, heparin dose, serum creatinine level, troponin I, and mortality between the two groups were insignificant(P>0.05). The blood losses, blood products transfusion, fibrinogen, D-dimer and thorax closure time were all significantly higher in group B(P<0.05). There was a statistically insignificant higher incidence of acute renal failure in group A.

Conclusion: Aprotinin decreases fibrinolysis, blood losses, and need for blood products transfusion in comparison to TA during adult cardiac surgery. It is however associated with a trend for an increased incidence of acute renal failure. Use of aprotinin should be useful for cases at high risk for bleeding such as redo surgery. It should be used cautiously in patients with preoperative renal impairment.

Keywords: Adult cardiac surgery, aprotinin, tranexamic acid, cardiopulmonary bypass, blood loss, blood products transfusion