Cardiac surgery with cardiopulmonary bypass: does aprotinin affect outcome?

Linden, Philippe J. Van der; Hardy, Jean‐François; Daper, Anne; Trenchant, Anne; Hert, Stefan De

doi:10.1093/bja/aem252

Cited by 21 publications

(10 citation statements)

References 40 publications

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“…The development of postoperative morbidities did not vary significantly between patients receiving low dose aprotinin and those receiving tranexamic acid which is consistent with finding from Van Der Linden's investigation [19]. Although aprotinin group experienced low morbidity and low mortality compared to tranexamic group, it did not reach statistical significance.…”

Section: A Seghrouchni Et Al World Journal Of Cardiovascular Diseasessupporting

confidence: 83%

Redo Cardiac Surgery: Bleeding Control

Seghrouchni¹,

Bamous²,

Moutakiallah³

et al. 2017

WJCD

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Redo cardiac surgery increases mortality and morbidity. The aim of this study was to determine if aprotinin was superior to tranexamic acid concerning control bleeding loss after redo valve surgery. A retrospective study was conducted from January 1994 until December 2014. 221 patients underwent redo cardiac valve surgery and separated into two groups: aprotinin group (n = 85) and tranexamic acid group (n = 136). Univariate tests were applied for data analysis. A total of 221 patients were enrolled in this study. This cohort was separated into two groups: aprotinin group (n = 85) and tranexamic acid group (n = 136). Euroscore in tranexamic acid group was higher: 5.96 ± 3.04 vs. 5.17 ± 2.83 in aprotinin group (p = 0.055). There was no statistical difference in postoperative mortality between the two groups (p = 0.153). No statistical differences were reported concerning: total blood loss (p = 0.51), red blood cells transfusion (p = 0.215), reexploration for bleeding (p = 0.537) and postoperative renal failure (p = 0.79). There were statistical differences concerning mechanical ventilation time, which is longer in tranexamic acid group (p = 0.008) and the use of inotropic drug support, which is more frequent in the tranexamic acid group (p = 0.001). Our results demonstrated that tranexamic acid and aprotinin reduce transfusion requirement and blood loss. Due to financial reason, we chose tranexamic acid in preventing blood loss in redo valve surgery.

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Section: A Seghrouchni Et Al World Journal Of Cardiovascular Diseasessupporting

confidence: 83%

Redo Cardiac Surgery: Bleeding Control

Seghrouchni¹,

Bamous²,

Moutakiallah³

et al. 2017

WJCD

View full text Add to dashboard Cite

show abstract

“…Thus, the data with regard to the effect of AP on renal function remain contradictory [24]. However, while some observational studies have not reported AP to be associated with adverse effects [21,22,25], a clear majority of observational studies using propensity score-matching methods to eliminate confounding, including ours, link AP with various serious adverse effects [2][3][4][5]20].…”

Section: Discussionmentioning

confidence: 98%

Use of aprotinin in cardiac surgery: effectiveness and safety in a population-based study☆

Jakobsen

Søndergaard

Hjortdal

2009

European Journal of Cardio-Thoracic Surgery

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“…[60,61] Several databases, both clinical and administrative revealed extremely divergent results. Even as some [62][63][64] found poor outcome with aprotinin, others [65][66][67][68] did not find any adverse effects of aprotinin. In risk-adjusted models comparing aprotinin (1343 patients) with EACA (6776 patients) and no antifibrinolytics (2029 patients), worse survival was observed in the aprotinin group.…”

Section: Post Aprotinin Dilemmamentioning

confidence: 96%

Antifibrinolytics in cardiac surgery

Dhir

2013

Ann Card Anaesth

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Cardiac surgery exerts a significant strain on the blood bank services and is a model example in which a multi-modal blood-conservation strategy is recommended. Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Hyper-fibrinolysis is one of the important contributors to increased bleeding. This knowledge has led to the use of anti-fibrinolytic agents especially in procedures performed under cardiopulmonary bypass. Nothing has been more controversial in recent times than the aprotinin controversy. Since the withdrawal of aprotinin from the world market, the choice of antifibrinolytic agents has been limited to lysine analogues either tranexamic acid (TA) or epsilon amino caproic acid (EACA). While proponents of aprotinin still argue against its non-availability. Health Canada has approved its use, albeit under very strict regulations. Antifibrinolytic agents are not without side effects and act like double-edged swords, the stronger the anti-fibrinolytic activity, the more serious the side effects. Aprotinin is the strongest in reducing blood loss, blood transfusion, and possibly, return to the operating room after cardiac surgery. EACA is the least effective, while TA is somewhere in between. Additionally, aprotinin has been implicated in increased mortality and maximum side effects. TA has been shown to increase seizure activity, whereas, EACA seems to have the least side effects. Apparently, these agents do not differentiate between pathological and physiological fibrinolysis and prevent all forms of fibrinolysis leading to possible thrombotic side effects. It would seem prudent to select the right agent knowing its risk-benefit profile for a given patient, under the given circumstances.

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Cardiac surgery with cardiopulmonary bypass: does aprotinin affect outcome?

Abstract: In the present study, patients receiving aprotinin as part of a strict blood conservation strategy represent a population at high risk for postoperative complications. For the outcome variables studied, aprotinin administration was not identified as an independent risk factor.

Cited by 21 publications

References 40 publications

Redo Cardiac Surgery: Bleeding Control

Redo Cardiac Surgery: Bleeding Control

Use of aprotinin in cardiac surgery: effectiveness and safety in a population-based study☆

Antifibrinolytics in cardiac surgery

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