Aprotinin use during cardiac surgery: recent alterations and effects on blood product utilization

Strouch, Z.Y.; Drum, Melinda L.; Chaney, Mark A.

doi:10.1016/j.jclinane.2008.12.021

Cited by 15 publications

(10 citation statements)

References 16 publications

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“…Use of tranexamic acid was associated with reduced blood loss, consistent with several other studies. 36,38,[63][64][65] Despite concerns about negative impact of aprotinin withdrawal on excessive blood loss, 66,67 our and other studies support the role of lysine analogs as viable alternatives. 38,64 Nonetheless, the observed association between higher surgical blood loss and increased risk of transfusion in our and other studies and the substantial intercenter variability in blood loss are indicative of further opportunities for improvement.…”

Section: Discussionmentioning

confidence: 96%

The second Austrian benchmark study for blood use in elective surgery: results and practice change

et al. 2014

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The second benchmark study demonstrates substantial intercenter variability and small but significant reductions in RBC transfusions and RBC loss. Even though the main independent predictors of transfusion were the relative lost RBC volume followed by the relative preoperative and the lowest relative postoperative hemoglobin, preoperative anemia was not adequately treated in many patients, underscoring the importance of patient blood management in these patients.

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Section: Discussionmentioning

confidence: 96%

The second Austrian benchmark study for blood use in elective surgery: results and practice change

et al. 2014

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“…Aprotinin was withdrawn from the market in 2007 due to high incidence of side effects and increased perioperative mortality. Some publications suggested that the withdrawal of aprotinin has been detrimental to patients undergoing cardiac surgery due to increased adverse outcomes and use of blood products [13] [14] [15]. Since Aprotinin is no longer available, TA is now considered as the first line antifibrinolytics.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of High Dose Tranexamic Acid in Decreasing Bleeding after Cardiac Surgery for Cyanotic Congenital Heart Disease in Children Less than Ten Kilo Body Weight

Sampathkumar¹,

Raju²,

Sadasivam³

et al. 2018

WJCS

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Background: To determine the effect of high dose tranexamic acid in decreasing immediate postoperative bleeding in children less than ten kilo body weight after complex cardiac surgery and also to evaluate the safety of high dose in small children. Methods: Between January-December 2015, 25 children weighing less than ten kilogram body weight underwent complex cardiac surgery for cyanotic congenital heart disease. All children were given dose of 100 mg/kg tranexamic acid at the time of anaesthetic induction and also 100 mg/kg into the CPB prime. The Median age and weight was 80 days (3-365) and 4.69 kg (2.4-7.8) respectively. The Median preoperative Hb was 10 g/dl (9.6-19.5 g/dl). Cardiac surgery included total intracardiac repair for TOF in 10 pts (40%), TAPVC repair in 6 (24%), arterial switch operation in 6 pts (24%), BD glenn in 1, repair of DORV with VSD in 1 and VSD closure with scimitar vein reimplantation in 1 pt. Median CPB time was 127 minutes (97-343) and cross clamp time was 99 (67-200) minutes. Moderate to deep hypothermia was maintained in all with median temperature of 24˚C (18-32). Three children (12%) had elective open chest in view of anticipated bleeding. Results: The Median postoperative drainage was 127 ml, (range 10-1250 ml). The median postoperative use of whole blood was 95 ml (range 10-275), packed cell was 187 ml (range 50-400 ml), frozen plasma was 88 ml (range 30-170), platelet concentrate was 57 ml, (range 10-100 ml) and cryoprecipitate was median 47.5 ml, (range 30-80 ml). No neurological dysfunction and renal dysfunction has been observed in any of the pts.

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“…What was seen by some was an increase in blood use without an effect on renal failure or early mortality, 20,21 as well as an increase in off-label use of recombinant factor VIIa. 22 No evidence was seen of an improvement in mortality by the lack of the use of aprotinin.…”

Section: Abbreviations and Acronymsmentioning

confidence: 99%

Aprotinin revisited

DeAnda

Spiess

2012

The Journal of Thoracic and Cardiovascular Surgery

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In 2008, we saw the withdrawal of aprotinin from the US markets after preliminary results from a large, randomized clinical trial in Canada. This drug, a potent antifibrinolytic, was used primarily in complex and/or redo cardiac surgery as an adjunct to decrease postoperative bleeding and complications. The Canadian study raised questions previously brought up in similar studies-does aprotinin increase the risk of mortality and renal failure after cardiac surgery? Recently, a re-review of the Canadian data noted flaws in the study, as well as in the interpretation of the results. The present review revisits the aprotinin controversy.

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Aprotinin use during cardiac surgery: recent alterations and effects on blood product utilization

Cited by 15 publications

References 16 publications

The second Austrian benchmark study for blood use in elective surgery: results and practice change

The second Austrian benchmark study for blood use in elective surgery: results and practice change

Efficacy of High Dose Tranexamic Acid in Decreasing Bleeding after Cardiac Surgery for Cyanotic Congenital Heart Disease in Children Less than Ten Kilo Body Weight

Aprotinin revisited

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