The Risks of Aprotinin and Tranexamic Acid in Cardiac Surgery: A One-Year Follow-Up of 1188 Consecutive Patients

Abstract

Both antifibrinolytic drugs bear the risk of adverse outcome depending on the type of cardiac surgery. Administration of aprotinin should be avoided in coronary artery bypass graft and high risk patients, whereas administration of tranexamic acid is not recommended in valve surgery.

The risks associated with aprotinin use: a retrospective study of cardiac cases in Nova Scotia

“…A recent study actually found that TXA had a greater association with renal failure compared with aprotinin, while aprotinin had a greater association with renal dysfunction. 11 In our study, acute renal failure occurred more often in the aprotinin group compared with the TXA group, although the magnitude of the difference was small. This is consistent with the majority of recent studies.…”

“…9,10 Reported safety concerns with aprotinin primarily include mortality, 5,8,9,11,12 renal failure, 6,12-14 renal dysfunction, 3,15,16 and stroke, 13,15,17 and, to a lesser extent, myocardial infarction. 13 In May 2008, the results of a randomized control trial, Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART), provided the most convincing evidence for the adverse outcomes associated with the use of aprotinin.…”

“…The majority of studies comparing TXA with aprotinin have shown that TXA is as safe or safer than aprotinin 6,13 ; however, one study has shown that TXA is associated with a higher incidence of seizures, atrial fibrillation, and renal failure when compared with aprotinin. 11 This shows our incomplete understanding of antifibrinolytics, specifically, their safety and adverse effect profiles. It also outlines the need for caution in administering any of the antifibrinolytics regardless of the type of surgery or patient profile.…”

Seizures following cardiac surgery: the impact of tranexamic acid and other risk factors

“…In three studies 7,22,23 that primarily investigated the hemostatic effects of aprotinin versus TA, patients receiving aprotinin had fewer seizures Results are the number of patients unless otherwise stated TA = tranexamic acid; CT = computed tomography; ICU = intensive care unit; EEG = electroencephalography (0-1.2%) than those having received TA (2.7-4.6%). 7,22,23 It is noteworthy that seizures were not reported by the BART investigators, although seizure was not an a priori defined endpoint in that trial. 12 There have been two recent reports that have specifically examined TA and seizures after cardiac surgery.…”

Tranexamic acid–associated seizures: Causes and treatment

“…However, observational clinical trials and case reports have shown that TXA, and to a lesser extent EACA, but not aprotinin, are associated with seizures 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34. Most TXA‐associated seizures occur in patients who have undergone cardiac procedures 16, 17, 18, 20, 21, 24, 25, 26, 30, 31, 32, 34. However, several case reports indicate that TXA‐associated seizures also occur in nonsurgical patients 10, 22, 27.…”