Related Experiment Video
Updated: Aug 11, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Avoiding transfusions in children undergoing cardiac surgery: a meta-analysis of randomized trials of aprotinin
Donald M Arnold1, Dean A Fergusson, Anthony K C Chan
1Canadian Blood Services, Hamilton, Ontario, Canada.
Insights
Aprotinin, an antifibrinolytic drug, significantly decreases blood transfusions in children undergoing cardiac surgery. However, it did not affect transfusion volume or drainage, and study quality was often poor.
Area of Science:
- Cardiology
- Pharmacology
- Pediatric Surgery
Background:
- Aprotinin is an antifibrinolytic agent used in adult cardiac surgery to reduce blood transfusions.
- Its efficacy in pediatric cardiac surgery remains uncertain.
- Cardiac surgery in children often necessitates blood transfusions.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) evaluating aprotinin's effect on blood transfusions in pediatric cardiac surgery.
- To assess the impact of aprotinin on transfusion rates, blood volumes, and chest tube drainage in children.
Main Methods:
- Systematic literature review of English-language RCTs.
- Inclusion criteria: aprotinin use in children undergoing cardiac surgery with cardiopulmonary bypass.
- Assessment of methodological quality and heterogeneity.
Main Results:
- Twelve trials with 626 children were included.
- Aprotinin reduced the proportion of children receiving red blood cell or whole blood transfusions by 33% (RR 0.67; 95% CI, 0.51-0.89).
- No significant effect on blood volume transfused or chest tube drainage was observed. Many studies had poor methodological quality.
Conclusions:
- Aprotinin effectively reduces the proportion of children requiring blood transfusions during cardiac surgery with cardiopulmonary bypass.
- Further high-quality trials are needed to confirm these findings and guide routine clinical recommendations.
- The drug's impact on transfusion volume and drainage requires further investigation.
Abstract:
Aprotinin, a potent antifibrinolytic drug, reduces the proportion of adults who receive blood transfusions during cardiac surgery, although the effect in children remains unclear. We performed a systematic review of the literature to identify all English language, randomized controlled trials of aprotinin involving children undergoing corrective or palliative cardiac surgery with cardiopulmonary bypass. All studies were assessed for methodological quality, and sources of heterogeneity were examined. We measured the effect of aprotinin on the proportion of children transfused, the volume of blood transfused, and the volume of chest tube drainage. Twelve trials enrolling 626 eligible children met the inclusion criteria. Aprotinin reduced the proportion of children who received red blood cell or whole blood transfusions during cardiac surgery by 33% (relative risk = 0.67; 95% confidence interval, 0.51 to 0.89). Aprotinin did not have a significant effect on the volume of blood transfused or on the amount of postoperative chest tube drainage. Most of the studies were of poor methodological quality and predefined transfusion triggers were infrequently used. Overall, aprotinin reduced the proportion of children who received blood transfusion during cardiac surgery with cardiopulmonary bypass. Further high-quality trials with clinically important outcomes may be warranted before aprotinin can be routinely recommended in this population.