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[Aprotinin in cardiac surgery: more risks than usefulness?]
D H Bremerich1, R Strametz, R Kirchner
1Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main. Bremerich@em.uni-frankfurt.de
Der Anaesthesist
|July 29, 2006
Summary
Antifibrinolytic drugs like tranexamic acid can reduce blood loss during cardiac surgery. A study suggests prioritizing tranexamic acid over aprotinin due to safety and cost-effectiveness concerns.
Area of Science:
- Cardiology
- Pharmacology
- Surgical Innovation
Background:
- Antifibrinolytic therapy is used to minimize blood loss in cardiac surgery.
- Key drugs include aprotinin, epsilon-aminocaproic acid, and tranexamic acid.
Purpose of the Study:
- To compare the effectiveness and safety of antifibrinolytic agents versus no therapy.
- To evaluate aprotinin, epsilon-aminocaproic acid, and tranexamic acid in cardiac surgery patients.
Main Methods:
- International, prospective, non-randomized Phase 4 observational study.
- Involved 4,374 patients undergoing cardiac surgery with extracorporeal circulation.
- Compared outcomes with aprotinin, epsilon-aminocaproic acid, tranexamic acid, and no antifibrinolytic therapy.
Main Results:
- The study by Mangano et al. raised concerns about the safety and efficacy of aprotinin for reducing perioperative blood loss.
- Despite critical review, the findings suggest potential risks associated with aprotinin.
Conclusions:
- Tranexamic acid is a viable and potentially safer alternative to aprotinin.
- Given cost-effectiveness in Germany, tranexamic acid is recommended over aprotinin for cardiac surgery patients.
