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Aprotinin use during cardiac surgery: recent alterations and effects on blood product utilization
Zaneta Y Strouch1, Melinda L Drum, Mark A Chaney
1Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL 60637, USA.
Insights
Reduced aprotinin use in cardiac surgery correlated with increased fresh frozen plasma (FFP) transfusions and a trend toward more reoperations for bleeding. This highlights the impact of antifibrinolytic drug protocols on blood product management and patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Aprotinin is an antifibrinolytic agent used to reduce blood loss during cardiac surgery.
- Changes in institutional protocols for aprotinin use can impact perioperative blood product management.
- Understanding these shifts is crucial for optimizing patient safety and resource utilization.
Purpose of the Study:
- To evaluate the impact of a single institution's changing aprotinin utilization on blood product use.
- To assess the relationship between aprotinin use and postoperative bleeding requiring reoperation.
- To analyze trends in red blood cell (RBC) and fresh frozen plasma (FFP) transfusions.
Main Methods:
- Retrospective study of 499 adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
- Comparison of data from two 12-month periods (February 2005-January 2006 vs. February 2006-January 2007).
- Analysis of patient demographics, surgical procedures, aprotinin dosage, and intraoperative/postoperative blood product utilization.
Main Results:
- Full-dose aprotinin use decreased significantly (58% to 17%), while non-use increased (18% to 47%).
- FFP utilization during CPB significantly increased (24% to 36%), as did combined RBC and FFP transfusions (23% to 34%).
- RBC transfusion rates remained stable, but a trend towards increased reoperations for bleeding was observed.
Conclusions:
- A significant decrease in high-dose aprotinin use was associated with increased FFP and FFP/RBC transfusions during CPB.
- The findings suggest a potential link between reduced aprotinin use and heightened need for blood products.
- A trend towards increased unplanned reoperations for excessive bleeding warrants further investigation.
Objective:
To investigate a single institution's changing use of aprotinin and subsequent effects on intraoperative blood product utilization (red blood cells/fresh frozen plasma) and postoperative clinical bleeding requiring reoperation.
Design:
Retrospective study.
Setting:
Single university institution (University of Chicago).
Measurements:
Data from 499 adult patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) over a two-year period (February 2005 - January 2007) were reviewed. The first 12 months (Feb 2005 - Jan 2006, Group 2005-2006) of data were compared with that from the second 12-month period (Feb 2006 - Jan 2007, Group 2006-2007). Information regarding patient demographics, surgical procedures, aprotinin use (none, half-dose, full-dose), and blood product use during CPB was retrospectively retrieved and analyzed.
Main Results:
When Group 2006-2007 data was compared with that from Group 2005-2006, full-dose aprotinin use had significantly decreased (58% to 17%, P < 0.001), non-use of aprotinin significantly increased (18% to 47%, P < 0.001), while fresh frozen plasma (FFP) utilization during CPB significantly increased (24% to 36%, P = 0.004). Red blood cell (RBC) transfusion rates remained stable (67% - 69%) yet rates of RBC and FFP transfusion during CPB significantly increased (23% to 34%, P = 0.003). There was also a trend toward increased unplanned reoperations for excessive clinical bleeding (0 pts in Group 2005-2006, three pts in Group 2006-2007).
Conclusions:
As the institution's use of high-dose aprotinin has significantly decreased, the number of patients requiring FFP and FFP/RBC combinations during CPB has significantly increased. Furthermore, a trend toward increasing incidence of unplanned reoperations for excessive clinical bleeding was noted.
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