Efficacy of aprotinin, epsilon aminocaproic acid, or combination in cyanotic heart disease

Chauhan, Sandeep; Kumar, Bisoi Akshay; Rao, Beeraka Heramba; Rao, Meenakshi; Dubey, B. L.; Saxena, Nita; Venugopal, Panangipalli

doi:10.1016/s0003-4975(00)01752-5

Cited by 65 publications

(62 citation statements)

References 12 publications

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“…This has been reduced with preoperative coil embolization of MAPCAs and intraoperative use of aprotinin and ε-aminocaproic acid. 18 These measures also reduced common intraoperative problems such as excessive bleeding due to sternotomy, shunt adhesions, and coagulopathy.…”

Section: Early Mortality and Morbiditymentioning

confidence: 99%

Tetralogy of Fallot in teenagers and adults: surgical experience and follow-up

Bisoi

Murala

Airan

et al. 2007

Gen Thorac Cardiovasc Surg

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Section: Early Mortality and Morbiditymentioning

confidence: 99%

Tetralogy of Fallot in teenagers and adults: surgical experience and follow-up

Bisoi

Murala

Airan

et al. 2007

Gen Thorac Cardiovasc Surg

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“…The administration of antifibrinolytics has emerged as a useful strategy to reduce perioperative blood loss and transfusion. Advantages of antifibrinolytics administration for reducing blood loss include patient tolerance of side effects (lysine analogues), ease of administration, inexpensive cost (the lysine analogues), and efficacy [7,8]. Specifically, aprotinin (a non-specific serine protease inhibitor) and two lysine-analogues, tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have demonstrated efficacy in reducing blood loss in pediatric cardiac surgery (pCS) [7] and pediatric spine surgery (pSS) [8], and their use is becoming more prevalent in pediatric craniofacial surgery (pCF) [9,10].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the use of antifibrinolytic agents in pediatric surgery and implications for craniofacial use

2012

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A systematic review aimed to evaluate the efficacy and safety of aprotinin, epsilon-aminocaproic acid (EACA), and tranexamic acid (TXA) in reducing perioperative blood loss, risk for transfusion, and total perioperative transfusion volume in major pediatric surgery. Medline, Embase, and Cochrane Reviews were searched for relevant articles published from January 1990 to January 2012. Additional studies were identified by cross-referencing citations and extracting data from recent published reviews. Data were recorded and analyzed using Cochrane's RevMan5.1 software. Thirty-four studies were included in this review of which 21 provided level 1b evidence, 11 were level 2b, and two were level 3b. As compared to control groups, antifibrinolytics reduced perioperative blood loss by standardized mean difference (SMD) of -0.70 (-0.89, -0.50; p<0.00001), total transfusion volume by SMD of -0.78 (-0.95, -0.61; p < 0.00001), and Odds Ratio (OR) for transfusion was 0.39 (0.23, 0.64; p=0.002). The OR for adverse events attributable to treatment was not statistically significant across groups (OR = 0.96; p = 0.58). Antifibrinolytics are effective in reducing blood loss and transfusion requirements in major pediatric surgery. TXA and EACA also appear to have reasonable side-effect profiles. Application to craniofacial surgery is promising, though further investigation is necessary.

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“…There have been 11 comparative studies of lysine analogs in pediatric patients totaling >1000 patients. 147,[445][446][447][448][449][450][451][452][453][454][455] These are well described in a recent review and meta-analysis, and Table 7 summarizes the results of these studies. 445,456 These studies are of varying quality, and more than half of the patients have come from a single institution, the All-India Institute of Medical Sciences.…”

Section: Prevention and Treatment Of Postoperative Coagulopathymentioning

confidence: 99%